1063942795 NPI number — MRS. AMBER J MCGINNIS LCPC

Table of content: MRS. AMBER J MCGINNIS LCPC (NPI 1063942795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063942795 NPI number — MRS. AMBER J MCGINNIS LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGINNIS
Provider First Name:
AMBER
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
AMBER
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063942795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
306 N MARKET ST STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT CARMEL
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62863-1519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-240-6517
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 N MARKET ST STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CARMEL
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62863-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-240-6517
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180.004673 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180.004673 . This is a "ILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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