Provider Demographics
NPI:1396876140
Name:COUNSELING & FAMILY SERVICES
Entity type:Organization
Organization Name:COUNSELING & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LADING-FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-676-2400
Mailing Address - Street 1:330 SW WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1406
Mailing Address - Country:US
Mailing Address - Phone:309-676-2400
Mailing Address - Fax:
Practice Address - Street 1:330 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1417
Practice Address - Country:US
Practice Address - Phone:309-676-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003685261QM0801X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180-003685Medicaid