Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 149006114 | IL |
NPI | 1003135179 |
---|---|
Provider Name | Constance J Arseneau |
First Address | Paxton, IL 60957-4090 |
Second Address | Paxton, IL 60957-4090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2010 |
Last Update Date | 27/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149006114 | STATE LICENSE NUMBER (01) | IL |