Organization
SIERRACOUNSELING & MEDIATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIVIAN MARIE SIERRA PH.D. (DIRECTOR)
(618) 398-6552
Entity
Organization
Contact information
Practice address
6609 W MAIN ST, SUITE A, BELLEVILLE, IL 62223-3025
(618) 398-6552
(618) 398-0075
Mailing address
6609 W MAIN ST, SUITE A, BELLEVILLE, IL 62223-3025
(618) 398-6552
(618) 398-0075
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
166.000561
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639199854
INDIVIDUAL NPI
IL
Enumeration date
11/18/2009
Last updated
11/18/2009
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