Individual
MR. JOHN C SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
23616 157TH AVE N, CORDOVA, IL 61242-9771
(309) 654-2402
(309) 654-2885
Mailing address
17204 RIVER RD N, CORDOVA, IL 61242-9735
(309) 654-2104
(309) 654-2885
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
IL
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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