Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 178.010223 | IL |
NPI | 1003340241 |
---|---|
Provider Name | Paige Minter |
First Address | West Frankfort, IL 62896-2210 |
Second Address | Alton, IL 62002-3915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2017 |
Last Update Date | 14/04/2017 |