SOUTHERN IL INSTITUTE OF BEHAVIORAL HEALTH PC (NPI# 1346562881) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346562881 |
| Entity Type | Organization |
| Organization Name | SOUTHERN IL INSTITUTE OF BEHAVIORAL HEALTH PC |
| Practice Address |
9 Junction Dr W Suite 6 Glen Carbon IL 62034-2931 |
| Mailing Address |
Po Box 98 Edwardsville IL 62025-0098 |
| Practice Telephone | 6187104123 |
| Practice Fax Number | 6187314082 |
| Mailing Telephone | 6187104123 |
| Mailing Fax Number | 6187314082 |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2012-05-19 |
| Authorized Official Name | MRS. TRACY LYNN SASHIDHARAN (TREASURER) |
| Authorized Official Telephone | 6187104123 |
| Authorized Official Credential | MA, NCC, LCPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
018.0007365 | IL | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
071.007775 | IL | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
071.007664 | IL | Behavioral Health & Social Service Providers |
| Street Address |
9 JUNCTION DR W SUITE 6 |
| City | GLEN CARBON |
| State | IL |
| Zip Code | 62034-2931 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487841714 | Renee Keller | Social Worker | 9 Junction Dr W, Suite 3, Glen Carbon, IL 62034-2931 | 2007-10-01 |
| 1609329523 | Emily Mooshegian | Counselor | 9 Junction Dr W, Suite 3, Glen Carbon, IL 62034-2931 | 2016-07-27 |
| 1497141048 | Cheryl L. Hennig | Psychologist | 9 Junction Dr W, Suite 3, Glen Carbon, IL 62034-2931 | 2015-04-10 |
| 1346680006 | Timothy L. Allen | Social Worker | 9 Junction Dr W, Glen Carbon, IL 62034-2931 | 2013-06-26 |
| 1124379755 | Mosaic Unlimited Inc | Social Worker | 9 Junction Dr W, Suite 2, Glen Carbon, IL 62034 | 2012-09-22 |
| 1326309717 | Amy Lynn Miller | Social Worker | 9 Junction Dr W, Suite 6, Glen Carbon, IL 62034-2931 | 2012-06-03 |
| 1760753677 | Victoria Elise Ginder | Social Worker | 9 Junction Dr W, Suite 3, Glen Carbon, IL 62034-2931 | 2012-01-24 |
| 1922399682 | Counselors Associates | Counselor | 9 Junction Dr W, Suite 2, Glen Carbon, IL 62034-2931 | 2011-04-28 |
| 1801020573 | Shannon Nicole Walker | Psychologist | 9 Junction Dr W, Suite 6, Glen Carbon, IL 62034-2931 | 2009-05-11 |
| 1437302411 | Teresa Ann Visintine | Social Worker | 9 Junction Dr W, Glen Carbon, IL 62034-2931 | 2008-11-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787795 | Kaleena Galletta | Nurse Practitioner | 4273 S., Il - 159, Glen Carbon, IL 62034 | 2018-04-06 |
| 1871092502 | Andrea Lee Sullivan | Dentist | 3024 South Il-159, Glen Carbon, IL 62034 | 2018-02-08 |
| 1417464918 | Stages Health & Wellness, LLC | Nurse Practitioner | 14 Crabapple Lane, Glen Carbon, IL 62034 | 2018-01-05 |
| 1700300498 | Michael Jay Arnold | Dentist | 3024 Il-159, Glen Carbon, IL 62034 | 2017-08-03 |
| 1679024228 | 360 Body Wellness Inc | Internal Medicine | 3407 Il State Route 157, Glen Carbon, IL 62034 | 2016-10-19 |
| 1346621505 | Stephanie N Lorts | Pediatrics | 4804 South State Route 159, Glen Carbon, IL 62034 | 2015-06-13 |
| 1205110111 | James Allan Staley | Pharmacist | #2 Cottonwood Rd, Glen Carbon, IL 62034 | 2011-10-11 |
| 1215224357 | Angela Eleni Kioultzopoulos | Speech-Language Pathologist | 7a Ginger Creek Village Dr., Glen Carbon, IL 62034 | 2011-07-08 |
| 1922320795 | Meridian Village Association | Skilled Nursing Facility | 27 Auerbach Place, Glen Carbon, IL 62034 | 2010-02-22 |
| 1679728356 | Erin Kathleen Immken | Counselor | 98 Junction Drive West, Suite 6, Glen Carbon, IL 62034 | 2008-11-24 |
| Find all providers in zip 62034 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497141048 | Cheryl L. Hennig | Psychologist | 9 Junction Dr W, Suite 3, Glen Carbon, IL 62034-2931 | 2015-04-10 |
| 1801020573 | Shannon Nicole Walker | Psychologist | 9 Junction Dr W, Suite 6, Glen Carbon, IL 62034-2931 | 2009-05-11 |
| 1881628782 | David T. Wells | Psychologist | 6-b Glen-ed Professional Park, Glen Carbon, IL 62034-3333 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699166 | Jennifer Knuepfer, Psyd, Pllc | Psychologist | 4256 N Ravenswood Ave Ste 305, Chicago, IL 60613-1114 | 2020-11-03 |
| 1104426170 | Grace Giedgowd | Psychologist | 1640 W Division St Apt 205, Chicago, IL 60622-3939 | 2020-10-29 |
| 1417556283 | Kjp Alliance LLC | Psychologist | 16595 W Easton Ave Ste 1, Lincolnshire, IL 60069-2744 | 2020-10-22 |
| 1184223364 | Caroline Elisabeth Fulton | Psychologist | 1739 N Elston Ave, Chicago, IL 60642-1544 | 2020-10-20 |
| 1881293108 | Haley Michelle Sims | Psychologist | 65 E Wacker Pl Ste 300, Chicago, IL 60601-7203 | 2020-10-19 |
| 1083212005 | Amanda Michele Long | Psychologist | 20280 Governors Hwy Ste 105, Olympia Fields, IL 60461-1068 | 2020-10-12 |
| 1285231936 | Qianhui Zhang | Psychologist | 1225 W Morse Ave Apt 403, Chicago, IL 60626-5751 | 2020-10-06 |
| 1316544158 | Nancy Marie Picard | Psychologist | 4885 N Hermitage Ave, Chicago, IL 60640-4104 | 2020-10-05 |
| 1558978379 | Youngok Kim | Psychologist | 1260 Iroquois Ave Ste 204, Naperville, IL 60563-8548 | 2020-09-25 |
| 1861007049 | Heloisa Garman | Psychologist | 800 Elgin Rd Apt 1611, Evanston, IL 60201-5632 | 2020-09-14 |
| Find all providers with the same taxonomy | ||||
| City | GLEN CARBON |
| Zip Code | 62034 |
Please comment or provide details below to improve the information on SOUTHERN IL INSTITUTE OF BEHAVIORAL HEALTH PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.