Individual
BRYANT WHALEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
202 W PARK AVE, CHAMPAIGN, IL 61820-3929
(217) 373-2430
Mailing address
1909 CYPRESS DR, CHAMPAIGN, IL 61821-5818
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/09/2010
Last updated
03/09/2010
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