Individual
AVERY J LISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHP
Contact information
Practice address
218 E MAIN ST, OLNEY, IL 62450-2114
(618) 395-8656
Mailing address
305 GREENVIEW DR APT 4, EFFINGHAM, IL 62401-3041
(217) 994-4445
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/29/2020
Last updated
06/29/2020
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