Organization
SOUTHERN ILLINOIS THERAPY SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA ANN KIMBLE LCSW (OWNER/LCSW)
(618) 218-4544
Entity
Organization
Contact information
Practice address
205 BAILEY LN STE 3W, BENTON, IL 62812-1921
(618) 218-4544
Mailing address
205 BAILEY LN STE 3W, BENTON, IL 62812-1921
(618) 218-4544
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/30/2022
Last updated
04/18/2022
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