Healthcare Provider Details

I. General information

NPI: 1063727675
Provider Name (Legal Business Name): BRENDA EYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 2ND ST
BEARDSTOWN IL
62618-1263
US

IV. Provider business mailing address

121 E 2ND ST
BEARDSTOWN IL
62618-1263
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-2980
  • Fax: 217-323-3731
Mailing address:
  • Phone: 217-323-2980
  • Fax: 217-323-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: