Provider Demographics
NPI:1427520352
Name:CREATING PEACE OF MIND COGNITIVE BEHAVIORAL HEALTH-LLC
Entity type:Organization
Organization Name:CREATING PEACE OF MIND COGNITIVE BEHAVIORAL HEALTH-LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DALSKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:618-408-1256
Mailing Address - Street 1:650 HILLSBORO AVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1865
Mailing Address - Country:US
Mailing Address - Phone:618-520-1764
Mailing Address - Fax:618-258-9400
Practice Address - Street 1:4010 N ILLINOIS ST STE D
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1967
Practice Address - Country:US
Practice Address - Phone:618-520-1764
Practice Address - Fax:618-825-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1326361502Medicaid