Individual
ANDREW BENJAMIN EYTALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
695 N PERRYVILLE RD STE 4, ROCKFORD, IL 61107-6225
(779) 368-0060
Mailing address
695 N PERRYVILLE RD, ROCKFORD, IL 61107-6225
(815) 975-3330
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178021163
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/17/2023
Last updated
07/31/2025
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