Preferred Behavioral Health Mso, INC.
Social Worker, Clinical in Fairview Heights, IL. Organization (NPI-2).
NPI number1962014472
StatusActive
Last updated in NPPESAug 18, 2020
Details
- NPI
- 1962014472
- Entity type
- Organization (NPI-2)
- Legal business name
- Preferred Behavioral Health Mso, INC.
- Organization subpart
- No
- Enumeration date
- Aug 18, 2020
- Certification date
- Aug 18, 2020
- Last updated
- Aug 18, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | – | Yes |
| 101YM0800X | Counselor, Mental Health | – | – | |
| 2084P0800X | Psychiatry & Neurology, Psychiatry | – | – | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – |
Other names
- Preferred Behavioral Health (Doing Business As)
- Itic Support Services, INC. (Former Legal Business Name)
Practice location
141 Market Pl Ste 100Fairview Heights, IL 62208-2089
Phone 618-398-4226 · Fax 618-398-1759
Mailing address
141 Market Pl Ste 100Fairview Heights, IL 62208-2089
Phone 618-398-4226 · Fax 618-398-1759
Authorized official
Ryan W Morris
President
2172427718
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