NPIMap

Organization Active NPI

South Eastern Illinois Counseling Center Inc

  • Community/Behavioral Health Agency
  • Olney, IL
National Provider Identifier
1730367624
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SOUTH EASTERN ILLINOIS COUNSELING CENTER INC
Practice address
209 S Camp Ave
Olney, IL 62450-1556
Phone
(618) 392-7916
NPI assigned
Feb 4, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2011

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, LCPC
Title
Executive Director
Phone
(618) 395-4309

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

209 S Camp Ave
Olney, IL 62450-1556

Mailing address

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

Other names 1

  • RICHLAND RESIDENCE APARTMENTS Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1202083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316044800000",
    "number": "1730367624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX M",
            "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": "209 S CAMP AVE",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624501556",
            "telephone_number": "618-392-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH EASTERN ILLINOIS COUNSELING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-04",
        "last_updated": "2011-09-15",
        "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": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RICHLAND RESIDENCE APARTMENTS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Olney, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2011; 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.