Organization
AMARYLLIS MIND, BODY, & SOUL COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVONNE LICAVOLI LCPC (PSYCHOTHERAPIST)
(314) 397-1428
Entity
Organization
Contact information
Practice address
4509 N ILLINOIS ST, SWANSEA, IL 62226-1524
(314) 669-5060
Mailing address
9626 RIDGE HEIGHTS RD, FAIRVIEW HEIGHTS, IL 62208-2319
(314) 397-1428
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/20/2023
Last updated
10/20/2023
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