=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447802756
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY MEYER LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2019
-----------------------------------------------------
Last Update Date | 11/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E LEFEVRE RD
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61081-1279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-625-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20169 PIGEON RD
-----------------------------------------------------
City | MORRISON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61270-9773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180014894
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------