Healthcare Provider Details

I. General information

NPI: 1497300149
Provider Name (Legal Business Name): JODY MCGUYER LCPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODY MCGUYER LCPC, CADC

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W. COURT ST.
KANKAKEE IL
60901-3640
US

IV. Provider business mailing address

315 W. COURT ST.
KANKAKEE IL
60901-3640
US

V. Phone/Fax

Practice location:
  • Phone: 708-977-7492
  • Fax:
Mailing address:
  • Phone: 708-977-7492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.012366
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: