Southpark Psychology Ltd

NPI #1558470419 in Moline, Illinois

Provider Information

NPI Number: 1558470419
Entity Type: Organization
Organization Name: Southpark Psychology Ltd
Primary Specialty: Psychologist - Counseling
Enumeration Date: Aug 30, 2006
Last Updated: Jan 26, 2018

Practice Location

Address: 2100 52ND AVE
City: Moline
State: Illinois
ZIP Code: 61265-6366
Phone: (309) 797-2900

Authorized Official

Name: DR. CARL VINCENT, LCPC
Title: OWNER
Phone: (309) 797-2900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X
Social Worker - Clinical — Clinical	1041C0700X
Counselor - Professional — Professional	101YP2500X
Psychologist - Counseling — Counseling	103TC1900X	Primary

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