NPIMap

Organization Active NPI

S E Illinois Counseling CTRS

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Robinson, IL
National Provider Identifier
1750550208
Registry record updated Sep 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
S E ILLINOIS COUNSELING CTRS
Practice address
204 W Highland Ave
Robinson, IL 62454-1710
Phone
(618) 546-1021
Fax
(618) 544-3791
NPI assigned
Feb 28, 2008
Last updated
Sep 15, 2011By the provider in NPPES
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) 395-4506

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

204 W Highland Ave
Robinson, IL 62454-1710

Mailing address

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

Other names 1

  • CRAWFORD 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.

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": "1316044800000",
    "number": "1750550208",
    "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": "204 W HIGHLAND AVE",
            "city": "ROBINSON",
            "state": "IL",
            "postal_code": "624541710",
            "telephone_number": "618-546-1021",
            "fax_number": "618-544-3791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S E ILLINOIS COUNSELING CTRS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "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": "618-395-4506",
        "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": true
        },
        {
            "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": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRAWFORD FAMILY COUNSELING CTR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Robinson, 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.