Itic Support Services Group LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

ITIC SUPPORT SERVICES GROUP LLC

Practice address

141 Market PL
Fairview Heights, IL 62208-2034

Phone

(314) 238-5260

NPI assigned

Dec 7, 2018

Organization subpart

Yes

Parent organization

ITIC SUPPORT SERVICES INCAs reported in NPPES

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

Authorized official

Name

Mr. Ryan W Morris

Title

Register Agent

Phone

(314) 238-5260

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 2

• ITIC Support Services Doing business as
• PREFERRED BEHAVIORAL HEALTH Doing business as

Part of

Itic Support Services Inc

Locations

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

{
    "created_epoch": "1544140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566864000000",
    "number": "1972074516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 MARKET PL",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082034",
            "telephone_number": "314-238-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 MARKET PL",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082034",
            "telephone_number": "314-238-5260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ITIC SUPPORT SERVICES GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ITIC SUPPORT SERVICES INC",
        "enumeration_date": "2018-12-07",
        "last_updated": "2019-08-27",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "REGISTER AGENT",
        "authorized_official_telephone_number": "314-238-5260",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164929055",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ITIC Support Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PREFERRED BEHAVIORAL HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Social Worker in Fairview Heights, IL
• Providers in Fairview Heights, 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 Aug 27, 2019; 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.