NPIMap

Organization Active NPI

Southern Il Institute of Behavioral Health PC

  • Clinical Psychologist
  • Glen Carbon, IL
National Provider Identifier
1346562881
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.007664 Issued in IL
Legal business name
SOUTHERN IL INSTITUTE OF BEHAVIORAL HEALTH PC
Practice address
9 Junction Dr W Ste 3
Glen Carbon, IL 62034-2931
Phone
(618) 710-4123
Fax
(618) 731-4082
NPI assigned
Feb 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

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

Authorized official

Name
Dr. Shannon Nicole Walker, PH.D.NPI 1801020573
Title
Owner/Clinical Psychologist
Phone
(618) 710-4123

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 018.0007365 IL
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 071.007664 IL Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

9 Junction Dr W Ste 3
Glen Carbon, IL 62034-2931

Mailing address

PO Box 98
Edwardsville, IL 62025-0098
Phone (618) 710-4123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100715000368 IL Part B Supplier - Clinic/Group Practice 8527190206 Receives reassigned benefits from 6 practitioners
Practice locations: Glen Carbon, IL

National Provider Directory

National Provider Directory

Locations

9 Junction Dr W
Ste 6
Glen Carbon, IL 62034
Phone (618) 710-4123

9 Junction Dr W
Ste 3
Glen Carbon, IL 62034
Phone (618) 710-4123

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1267056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788220800000",
    "number": "1346562881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620250098",
            "telephone_number": "618-710-4123",
            "fax_number": "618-731-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 JUNCTION DR W STE 3",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620342931",
            "telephone_number": "618-710-4123",
            "fax_number": "618-731-4082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN IL INSTITUTE OF BEHAVIORAL HEALTH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-25",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER/CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "618-710-4123",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "018.0007365",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.007664",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Carbon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.