Provider Demographics
NPI:1417010760
Name:PERRY COUNTY COUNSELING CENTER INC
Entity type:Organization
Organization Name:PERRY COUNTY COUNSELING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VENSKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-542-4357
Mailing Address - Street 1:1016 S MADISON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-2442
Mailing Address - Country:US
Mailing Address - Phone:618-542-4357
Mailing Address - Fax:618-542-3442
Practice Address - Street 1:1016 S MADISON ST
Practice Address - Street 2:SUITE A
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-2442
Practice Address - Country:US
Practice Address - Phone:618-542-4357
Practice Address - Fax:618-542-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health