Community Life Concepts of Southern Illinois, Npc
NPI #1336292135 in Murphysboro, Illinois
Provider Information
- NPI Number
- 1336292135
- Entity Type
- Organization
- Organization Name
- Community Life Concepts of Southern Illinois, Npc
- Primary Specialty
- Social Worker - Clinical
- Enumeration Date
- Jan 18, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 473 W HARRISON RD
- City
- Murphysboro
- State
- Illinois
- ZIP Code
- 62966-4782
- Phone
- (618) 867-2222
Authorized Official
- Name
- DR. PHILIP C NORDSTROM, PHD
- Title
- REGISTERED AGENT
- Phone
- (618) 867-2222
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
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