NPIMap

Organization Active NPI

S E Illinois Counseling CTRS

  • Addiction (Substance Use Disorder) Counselor
  • Fairfield, IL
National Provider Identifier
1013186568
Registry record updated May 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
S E ILLINOIS COUNSELING CTRS
Practice address
407 N Basin Rd
Fairfield, IL 62837-9639
Phone
(618) 842-2125
Fax
(618) 842-2126
NPI assigned
Feb 28, 2008
Last updated
May 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Glenn Jackson, M. DIV., LSW, LCPCNPI 1568833283
Title
Executive Director
Phone
(618) 395-4309

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

407 N Basin Rd
Fairfield, IL 62837-9639

Mailing address

PO Box M
504 Micah Drive
Olney, IL 62450-0913
Phone (618) 395-4306

Other names 1

  • WAYNE FAMILY COUNSELING CTR Other name

National Provider Directory

National Provider Directory
Tax ID family
Southeastern Ill Counsc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462406400000",
    "number": "1013186568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX M",
            "address_2": "504 MICAH DRIVE",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624500913",
            "telephone_number": "618-395-4306",
            "fax_number": "618-395-4507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 N BASIN RD",
            "city": "FAIRFIELD",
            "state": "IL",
            "postal_code": "628379639",
            "telephone_number": "618-842-2125",
            "fax_number": "618-842-2126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S E ILLINOIS COUNSELING CTRS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2016-05-05",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-395-4309",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M. DIV., LSW, LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WAYNE FAMILY COUNSELING CTR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fairfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.