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General NPI Number Information
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NPI Number | 1497556286
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Entity Type | Organization
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Legal Business Name | NEUROTHERAPY INSTITUTE, PLLC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 8420 N KNOXVILLE AVE SUITE C PMB 1043
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City | PEORIA
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State | IL
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Zip | 61615
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Country | US
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Telephone | 309-202-4417
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Fax |
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Provider Business Mailing Address
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Address Line | 8420 N KNOXVILLE AVE SUITE C PMB 1043
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City | PEORIA
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State | IL
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Zip | 61615
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Country | US
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Telephone | 309-202-4417
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PROFESSIONAL COUN
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Name | SHANE G. YOUNG
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Credential | MA, NCC, LCPC
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Telephone | 309-202-4177
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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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