MEDICARE: MRS. ELIZABETH A HENSLEY M.S., L.C.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180.001785	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11928344	OTHER	IL	CAQH PROVIDER

General Provider Information

NPI Number	:	1427062413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH A HENSLEY M.S., L.C.P.C.

Provider Business Mailing Address
First Line	:	4112 N WATER TOWER PL
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6295
Country	:	US
Telephone Number	:	618-242-6944
Fax Number	:	618-242-6726

Provider Business Practice Location Address
First Line	:	4112 N WATER TOWER PL
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6295
Country	:	US
Telephone Number	:	618-242-6944
Fax Number	:	618-242-6726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	04/06/2014

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