Healthcare Provider Details

I. General information

NPI: 1528989753
Provider Name (Legal Business Name): AMY L TINSLEY CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 APPLE AVE
MOUNT VERNON IL
62864-2418
US

IV. Provider business mailing address

3208 APPLE AVE
MOUNT VERNON IL
62864-2418
US

V. Phone/Fax

Practice location:
  • Phone: 618-534-1271
  • Fax:
Mailing address:
  • Phone: 618-534-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number45379
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: