NPIMap

Organization Active NPI

Perry County Counseling Center Inc

  • Professional Counselor
  • Du Quoin, IL
National Provider Identifier
1538301577
Registry record updated Apr 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180004129 Issued in IL
Legal business name
PERRY COUNTY COUNSELING CENTER INC
Practice address
110 S Hickory St
Du Quoin, IL 62832-1839
Phone
(618) 542-6722
Fax
(618) 542-6623
NPI assigned
Apr 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2009

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

Authorized official

Name
John R Venskus
Title
Executive Director
Phone
(618) 542-4357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 180004129 IL Primary

Addresses

Primary practice location

110 S Hickory St
Du Quoin, IL 62832-1839

Mailing address

8271 E Jackson Street Rd
Du Quoin, IL 62832-3811
Phone (618) 542-6722

Other identifiers 1

IdentifierTypeStateIssuer
012300790MedicaidIL

Other names 1

  • Southern Illinois Behavioral Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040427001264 IL Part B Supplier - Clinic/Group Practice 5092702597 Receives reassigned benefits from 5 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Du Quoin, IL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Perry County Counseling Center Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1016 S Madison St
#A
Du Quoin, IL 62832
Phone (618) 542-4357

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238976000000",
    "number": "1538301577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8271 E JACKSON STREET RD",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628323811",
            "telephone_number": "618-542-6722",
            "fax_number": "618-542-6623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 S HICKORY ST",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628321839",
            "telephone_number": "618-542-6722",
            "fax_number": "618-542-6623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY COUNTY COUNSELING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2009-04-06",
        "status": "A",
        "authorized_official_last_name": "VENSKUS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-542-4357"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180004129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012300790",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Illinois Behavioral Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Du Quoin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2009; 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.