Provider Demographics
NPI:1194336784
Name:EARTH WATER AIR COUNSELING, LLC
Entity type:Organization
Organization Name:EARTH WATER AIR COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SCARLETT
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:217-242-7451
Mailing Address - Street 1:1161 FORTUNE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7385
Mailing Address - Country:US
Mailing Address - Phone:618-777-6670
Mailing Address - Fax:877-811-5628
Practice Address - Street 1:1161 FORTUNE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7385
Practice Address - Country:US
Practice Address - Phone:618-777-6670
Practice Address - Fax:877-811-5628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-16
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health