Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 31975 | IL |
NPI | 1003446717 |
---|---|
Provider Name | Michelle Humel |
First Address | Effingham, IL 62401-3764 |
Second Address | Effingham, IL 62401-3764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2020 |
Last Update Date | 22/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1234 | COUNSELING (01) | IL |