Organization
S E ILLINOIS COUNSELING CTRS
Active
Other names
CRAWFORD FAMILY COUNSELING CTR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN JACKSON M. DIV., LSW, LCPC (EXECUTIVE DIRECTOR)
(618) 395-4506
Entity
Organization
Contact information
Practice address
204 W HIGHLAND AVE, ROBINSON, IL 62454-1710
(618) 546-1021
(618) 544-3791
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
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
02/28/2008
Last updated
09/15/2011
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