Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178.016732 | IL |
NPI | 1003582149 |
---|---|
Provider Name | Calysta Will |
First Address | Mchenry, IL 60050-4007 |
Second Address | Mchenry, IL 60050-4007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/08/2021 |