Monarch Trauma Counseling Center

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149014325 Issued in IL

Legal business name

MONARCH TRAUMA COUNSELING CENTER

Practice address

1630 5TH Ave
Suite 429
Moline, IL 61265-7914

Phone

(309) 764-4733

Fax

(309) 764-2424

NPI assigned

Oct 15, 2012

Last updated

Oct 15, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Sally Melissas Miskinis, LCSW

Title

Co-Owner

Phone

(309) 764-4733

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350259200000",
    "number": "1710239793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 5TH AVE",
            "address_2": "SUITE 429",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "61265",
            "telephone_number": "309-764-4733",
            "fax_number": "309-764-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 5TH AVE",
            "address_2": "SUITE 429",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612657914",
            "telephone_number": "309-764-4733",
            "fax_number": "309-764-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONARCH TRAUMA COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-15",
        "last_updated": "2012-10-15",
        "status": "A",
        "authorized_official_last_name": "MISKINIS",
        "authorized_official_first_name": "SALLY",
        "authorized_official_middle_name": "MELISSAS",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "309-764-4733",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180003695",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149014325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moline NH LLC (River Crossing of Moline)
• Moline Nursing and Rehabilitation LLC
• Moline Rem Center, LLC
• Moline Unit School District 40
• Jessica Molnar
• Greg Monson, PT
• Brooke E Montgomery
• Jennifer Grace Moore
• Matthew J Moore, P.T.
• Ana Lilia Morales-Mackay, LMFT

• Clinical Social Worker in Moline, IL
• Providers in Moline, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; 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.