Provider Demographics
NPI:1366185985
Name:PRICE, ERIC (MA, QMHP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1660
Mailing Address - Country:US
Mailing Address - Phone:618-658-3079
Mailing Address - Fax:618-658-2759
Practice Address - Street 1:101 OLIVER ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1660
Practice Address - Country:US
Practice Address - Phone:618-658-3079
Practice Address - Fax:618-658-2759
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health