Healthcare Provider Details

I. General information

NPI: 1831008515
Provider Name (Legal Business Name): DALTON LEE HEBBELER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E CLARK TRL APT 1
HERRIN IL
62948-4282
US

IV. Provider business mailing address

416 E CLARK TRL APT 1 10364 1/2 MITCHELL STREET
HERRIN IL
62948-4282
US

V. Phone/Fax

Practice location:
  • Phone: 618-923-3457
  • Fax: 618-615-4578
Mailing address:
  • Phone: 618-923-3457
  • Fax: 618-615-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: