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General NPI Number Information
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NPI Number | 1790165389
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Entity Type | Organization
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Legal Business Name | CAROLLYN MCKINSTRY
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 773 W LINCOLN ST SUITE 201A
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City | FREEPORT
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State | IL
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Zip | 61032-4976
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Country | US
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Telephone | 815-618-4152
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Fax |
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Provider Business Mailing Address
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Address Line | 773 W LINCOLN BLVD SUITE 201A
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City | FREEPORT
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State | IL
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Zip | 61032-4978
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Country | US
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Telephone | 815-618-4152
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | CAROLLYN MCKINSTRY
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Credential | LCPC
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Telephone | 815-618-4152
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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 | 180.006239
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License Number State | IL
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