Organization
S E ILLINOIS COUNSELING CTRS INC
Active
Other names
WABASH FAMILY COUNSELING CTR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN JACKSON M. DIV., LSW, LCPC (EXECUTIVE DIRECTOR)
(618) 395-4509
Entity
Organization
Contact information
Practice address
602 E 5TH ST, MOUNT CARMEL, IL 62863-2152
(618) 262-7473
(618) 263-6579
Mailing address
PO BOX M, 504 MICAH DRIVE, OLNEY, IL 62450-0913
(618) 395-4306
(618) 395-4507
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/28/2008
Last updated
05/05/2016
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