Itic Support Services Group LLC
NPI #1972074516 in Fairview Heights, Illinois
Provider Information
- NPI Number
- 1972074516
- Entity Type
- Organization
- Organization Name
- Itic Support Services Group LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- ITIC SUPPORT SERVICES INC
- Primary Specialty
- Social Worker - Clinical
- Enumeration Date
- Dec 7, 2018
- Last Updated
- Aug 27, 2019
Practice Location
- Address
- 141 MARKET PL
- City
- Fairview Heights
- State
- Illinois
- ZIP Code
- 62208-2034
- Phone
- (314) 238-5260
Authorized Official
- Name
- MR. RYAN W MORRIS
- Title
- REGISTER AGENT
- Phone
- (314) 238-5260
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychiatry & Neurology - Psychiatry — Psychiatry |
| Nurse Practitioner - Family — Family |
| Nurse Practitioner - Psychiatric/Mental Health — Psychiatric/Mental Health |
| Social Worker - Clinical — Clinical |
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