Provider Demographics
NPI:1699056564
Name:PERRY COUNTY COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:PERRY COUNTY COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MBA
Authorized Official - Phone:618-542-5421
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 1:8271 E JACKSON STREET RD
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-3811
Practice Address - Country:US
Practice Address - Phone:618-542-6722
Practice Address - Fax:618-542-6623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)