Provider Demographics
NPI:1427503788
Name:EAST DUBUQUE COUNSELING LTD.
Entity type:Organization
Organization Name:EAST DUBUQUE COUNSELING LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIEUNN
Authorized Official - Middle Name:SYNNTHIEA SERRIE
Authorized Official - Last Name:MUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-306-8089
Mailing Address - Street 1:430 SIDNEY ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EAST DUBUQUE
Mailing Address - State:IL
Mailing Address - Zip Code:61025-1175
Mailing Address - Country:US
Mailing Address - Phone:815-306-8089
Mailing Address - Fax:
Practice Address - Street 1:430 SIDNEY ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:EAST DUBUQUE
Practice Address - State:IL
Practice Address - Zip Code:61025-1175
Practice Address - Country:US
Practice Address - Phone:815-306-8089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003386251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health