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Organization

BACK TO BASICS COUNSELING, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAYMIE L MCCAMMON (LCSW)
(779) 220-0441
Entity
Organization

Contact information

Practice address
106 N MAIN ST, DECATUR, IL 62523-1207
(217) 821-8269
Mailing address
106 N MAIN ST, DECATUR, IL 62523-1207
(779) 220-0441

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1194099853
NPI 1
IL
Enumeration date
06/04/2020
Last updated
07/17/2020
Update your record

If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.

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