Provider Demographics
NPI:1215447610
Name:SOS CRISIS INTERVENTION, LLC
Entity type:Organization
Organization Name:SOS CRISIS INTERVENTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:618-335-2938
Mailing Address - Street 1:4020 GREEN MOUNT CROSSING DR # 325
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7287
Mailing Address - Country:US
Mailing Address - Phone:618-335-2938
Mailing Address - Fax:618-551-4377
Practice Address - Street 1:901 TERRACE CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3437
Practice Address - Country:US
Practice Address - Phone:618-335-2938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty