Southern Illinois Therapy Services, PLLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SOUTHERN ILLINOIS THERAPY SERVICES, PLLC

Practice address

205 Bailey LN Ste 3W
Benton, IL 62812-1921

Phone

(618) 218-4544

NPI assigned

Mar 30, 2022

Organization subpart

No

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

Authorized official

Name

Samantha Ann Kimble, LCSWNPI 1083230098

Title

Owner/LCSW

Phone

(618) 218-4544

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Samantha Ann Kimble, LCSW

  • Clinical Social Worker
  • Benton, IL
  • NPI 1083230098
  NPD Authorized official

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1891435657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 BAILEY LN STE 3W",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121921",
            "telephone_number": "618-218-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 BAILEY LN STE 3W",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121921",
            "telephone_number": "618-218-4544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS THERAPY SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-30",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "KIMBLE",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/LCSW",
        "authorized_official_telephone_number": "618-218-4544",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Simpson
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• Southern Illinois Medical Services, NFP
• Southern Illinois Sport and Spine LLC
• Spencer Family Eye Care, LLC
• David Keith Spencer, O.D.
• Michael Sebastian Spencer, O.D.
• Chelsea Steele
• Hannah Stock

• Mental Health Clinic/Center (Including Community Mental Health Center) in Benton, IL
• Providers in Benton, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; 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.