NPIMap

Organization Active NPI

S E Illinois Counseling CTRS Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Newton, IL
National Provider Identifier
1841469491
Registry record updated Apr 20, 2008
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 INC.
Practice address
902 W Jourdan St
Newton, IL 62448-1062
Phone
(618) 783-8615
Fax
(618) 783-4174
NPI assigned
Feb 28, 2008
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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) 395-4306

Specialties & licenses 4

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

Addresses

Primary practice location

902 W Jourdan St
Newton, IL 62448-1062

Mailing address

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

Other names 1

  • JASPER 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.

Locations

902 W Jourdan St
Newton, IL 62448
Phone (618) 783-8615

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": "1208649600000",
    "number": "1841469491",
    "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": "902 W JOURDAN ST",
            "city": "NEWTON",
            "state": "IL",
            "postal_code": "624481062",
            "telephone_number": "618-783-8615",
            "fax_number": "618-783-4174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S E ILLINOIS COUNSELING CTRS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-395-4306",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JASPER FAMILY COUNSELING CTR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Newton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.