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NPI Code Detail

MEDICARE: KACEY RILEY LCSW

MEDICARE: KACEY RILEY LCSW
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 Counselor

General Provider Information

NPI Number : 1831358035
Entity Type Code : Individual
Provider Name (Legal Business Name) : KACEY RILEY LCSW
Provider Business Mailing Address
First Line : 1810 W SOUTH 3RD ST
Second Line :
City : SHELBYVILLE
State : IL
Zip : 62565-9595
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1810 W SOUTH 3RD ST
Second Line :
City : SHELBYVILLE
State : IL
Zip : 62565-9595
Country : US
Telephone Number : 217-774-2113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2008
Last Update Date : 09/30/2014

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Directions to “ KACEY RILEY LCSW” Practice Location

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