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NPI Code Detail

MEDICARE: WEBSTER CANTRELL YOUTH ADVOCACY

MEDICARE: WEBSTER CANTRELL YOUTH ADVOCACY
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
1104100000XSocial Worker
2163W00000XRegistered Nurse
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1841830429
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEBSTER CANTRELL YOUTH ADVOCACY
Provider Business Mailing Address
First Line : 1942 E CANTRELL ST
Second Line :
City : DECATUR
State : IL
Zip : 62521-3214
Country : US
Telephone Number : 217-423-6961
Fax Number : 217-421-6889
Provider Business Practice Location Address
First Line : 1942 E CANTRELL ST
Second Line :
City : DECATUR
State : IL
Zip : 62521-3214
Country : US
Telephone Number : 217-423-6961
Fax Number : 217-421-6889
Authorized Official
Title or Position : CEO
Name : MR. MICHAEL WARNER
Credential :
Telephone Number : 217-423-6961
Provider Enumeration Date : 01/10/2020
Last Update Date : 05/17/2021

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1578990842 — MS. CHRISTIANA MARIE HOPPER LCPC
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62521-3214
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1528421203 — PETER HOPKINS
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62521-3214
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1275124687 — SHELBY GERALDS
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Directions to “WEBSTER CANTRELL YOUTH ADVOCACY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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