Provider Demographics
NPI:1023726213
Name:IMAN, EMILY AHRLING (LCSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:AHRLING
Last Name:IMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 W COUNTY RD STE E
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2598
Mailing Address - Country:US
Mailing Address - Phone:618-706-1004
Mailing Address - Fax:
Practice Address - Street 1:722 W COUNTY RD STE E
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2598
Practice Address - Country:US
Practice Address - Phone:618-706-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.025364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1871832709OtherKOEN COUNSELING