MEDICARE: AMY WEBSTER MA,MHP

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	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	261QM0801X	IL

General Provider Information

NPI Number	:	1891486338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY WEBSTER MA,MHP

Provider Business Mailing Address
First Line	:	106 EDWARDS ST
Second Line	:
City	:	NEWTON
State	:	IL
Zip	:	62448-1736
Country	:	US
Telephone Number	:	618-783-4154
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 S WHITTLE AVE
Second Line	:
City	:	OLNEY
State	:	IL
Zip	:	62450-2262
Country	:	US
Telephone Number	:	618-392-3226
Fax Number	:

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

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	05/16/2023

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