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NPI Code Detail

MEDICARE: CHRISTINE RENEE DELGADO LCPC

MEDICARE: CHRISTINE RENEE DELGADO LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor180007056IL

General Provider Information

NPI Number : 1366686032
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE RENEE DELGADO LCPC
Provider Business Mailing Address
First Line : 114 WHITELAW AVE
Second Line :
City : WOOD RIVER
State : IL
Zip : 62095-1911
Country : US
Telephone Number : 618-251-4225
Fax Number : 618-251-4586
Provider Business Practice Location Address
First Line : 114 WHITELAW AVE
Second Line :
City : WOOD RIVER
State : IL
Zip : 62095-1911
Country : US
Telephone Number : 618-251-4224
Fax Number : 618-251-4586
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2009
Last Update Date : 04/26/2009

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