Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180.010502 | IL |
NPI | 1003322967 |
---|---|
Provider Name | Yvette Camacho |
First Address | Alsip, IL 60803-4232 |
Second Address | Chicago, IL 60657-3122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2017 |
Last Update Date | 14/12/2017 |