Organization Name: | STATELINE COUNSELING SERVICES LLC |
NPI Number: | 1033551320 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHELLY LYNNE PATCHETT (OWNER) |
Mailing Address: | 1107 N Blackhawk Blvd Suite 8 Rockton |
State: | IL US |
Postal Code: | 610721500 |
Phone Number: | 8154949115 |
Fax Number: | 8159265301 |
NPI Enumeration Date: | 07/26/2013 |
NPI Last Update Date: | 07/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 149.009828 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |