Provider Demographics
NPI:1104419365
Name:COPING WITH CHOICES THERAPY GROUP LLC
Entity type:Organization
Organization Name:COPING WITH CHOICES THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:SUZETTE
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-825-8173
Mailing Address - Street 1:4020 GREEN MOUNT CROSSING DR STE 108
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7287
Mailing Address - Country:US
Mailing Address - Phone:618-825-8173
Mailing Address - Fax:
Practice Address - Street 1:1151 BOULDER CREEK DRIVE
Practice Address - Street 2:APT 104
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-0079
Practice Address - Country:US
Practice Address - Phone:618-825-8173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty