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NPI Code Detail

MEDICARE: BRONWYN RAINS LCPC

MEDICARE: BRONWYN RAINS LCPC
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
1101YM0800XMental Health Counselor180002733IL

General Provider Information

NPI Number : 1508005125
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRONWYN RAINS LCPC
Provider Business Mailing Address
First Line : 5230 S 6TH STREET RD
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-5128
Country : US
Telephone Number : 217-585-1180
Fax Number : 217-585-4747
Provider Business Practice Location Address
First Line : 5230 S 6TH STREET RD
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-5128
Country : US
Telephone Number : 217-585-1180
Fax Number : 217-585-4747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2009
Last Update Date : 02/05/2009

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