Provider Demographics
NPI:1902554629
Name:MFG COUNSELING SERVICES. LLC
Entity type:Organization
Organization Name:MFG COUNSELING SERVICES. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FULTON-GORHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-219-5384
Mailing Address - Street 1:1329 W CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-2501
Mailing Address - Country:US
Mailing Address - Phone:309-219-5384
Mailing Address - Fax:
Practice Address - Street 1:5016 N UNIVERSITY ST STE 101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4763
Practice Address - Country:US
Practice Address - Phone:309-219-5384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty