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General NPI Number Information
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NPI Number | 1336979400
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Entity Type | Organization
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Legal Business Name | LIVING CONSCIOUSLY MENTAL HEALTH LLC
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Dates
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Enumeration Date | 08/05/2024
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 221 N RANDOLPH ST
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City | MACOMB
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State | IL
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Zip | 61455-2217
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Country | US
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Telephone | 309-333-5578
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Fax |
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Provider Business Mailing Address
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Address Line | 221 N RANDOLPH ST
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City | MACOMB
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State | IL
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Zip | 61455-2217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | AMY BUWICK
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Credential |
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Telephone | 309-333-5578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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