Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 178.004408 | IL |
N | 101YM0800X | Mental Health Counselor | 178.004408 | IL |
N | 101YP1600X | Pastoral Counselor | 178.004408 | IL |
Y | 101YP2500X | Professional Counselor | 178.004408 | IL |
NPI | 1194087445 |
---|---|
Provider Name | Rebecca Payne |
First Address | Springfield, IL 62711-9203 |
Second Address | Springfield, IL 62711-9203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 20/06/2012 |