1710239793 NPI number — MONARCH TRAUMA COUNSELING CENTER

Table of content: (NPI 1710239793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710239793 NPI number — MONARCH TRAUMA COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONARCH TRAUMA COUNSELING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710239793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1630 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 429
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-764-4733
Provider Business Mailing Address Fax Number:
309-764-2424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1630 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 429
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-7914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-764-4733
Provider Business Practice Location Address Fax Number:
309-764-2424
Provider Enumeration Date:
10/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MISKINIS
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
MELISSAS
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
309-764-4733

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180003695 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 149014325 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com