Individual
JOSHUA B THEISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
12 N 64TH ST, BELLEVILLE, IL 62223-3809
(618) 877-4420
(618) 397-0093
Mailing address
448 WYLIE DR, NORMAL, IL 61761-5405
(888) 924-3786
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180009668
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
180.009668
IL
101YM0800X
Mental Health Counselor
180.009668
IL
Other
Enumeration date
04/25/2018
Last updated
08/10/2020
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