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General NPI Number Information
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NPI Number | 1760064489
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Entity Type | Organization
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Legal Business Name | GUIDED HEALING
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 6209 E MAIN ST
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City | MARYVILLE
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State | IL
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Zip | 62062-2015
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Country | US
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Telephone | 618-917-4207
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Fax |
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Provider Business Mailing Address
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Address Line | 343 MOULTRIE LN
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City | O FALLON
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State | IL
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Zip | 62269-7174
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Country | US
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Telephone | 618-917-4207
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. ANDILYN BURGESS
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Credential | LCPC
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Telephone | 618-917-4207
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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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