Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1023561222 |
---|---|
Provider Name | Courtney Mounce |
First Address | Waukegan, IL 60085-2321 |
Second Address | Waukegan, IL 60085-2321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2016 |
Last Update Date | 25/07/2016 |