MEDICARE: CARA WELLS NIEBUR LPC

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	178016771	IL

General Provider Information

NPI Number	:	1467134197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA WELLS NIEBUR LPC

Provider Business Mailing Address
First Line	:	1120 N MELVIN ST
Second Line	:
City	:	GIBSON CITY
State	:	IL
Zip	:	60936-1477
Country	:	US
Telephone Number	:	217-784-4251
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 HAGER DR
Second Line	:
City	:	GIBSON CITY
State	:	IL
Zip	:	60936-1040
Country	:	US
Telephone Number	:	217-784-2146
Fax Number	:	217-784-1327

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

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	02/14/2024

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