MEDICARE: AMBER L WEYHRICH MA, LPC

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
1	101YP2500X	Professional Counselor	178-014988	IL

General Provider Information

NPI Number	:	1780222992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER L WEYHRICH MA, LPC

Provider Business Mailing Address
First Line	:	7058 QUAIL RUN RD
Second Line	:
City	:	IUKA
State	:	IL
Zip	:	62849-1218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4114 N WATER TOWER PL STE F
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6548
Country	:	US
Telephone Number	:	618-316-7058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	12/18/2019

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