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General NPI Number Information
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NPI Number | 1689431199
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Entity Type | Individual
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Provider Name | EMERSON BLACK MA, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 217 GLENWOOD AVE
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City | WILLOW SPRINGS
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State | IL
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Zip | 60480-1307
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Country | US
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Telephone | 574-283-0438
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8461
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City | CHICAGO
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State | IL
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Zip | 60608-0461
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Country | US
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Telephone | 512-944-2979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.020205
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License Number State | IL
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