Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178.010764 | IL |
NPI | 1003260431 |
---|---|
Provider Name | Michael Ragan |
First Address | Channahon, IL 60410-5215 |
Second Address | Channahon, IL 60410-5215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2016 |
Last Update Date | 21/04/2016 |