Individual
MR. COLEMAN RILEY VIZCARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
904 E. MARTIN LUTHER KING DR., CENTRALIA, IL 62801
(618) 533-1391
(618) 533-0012
Mailing address
904 E. MARTIN LUTHER KING DR., CENTRALIA, IL 62801
(618) 533-1391
(618) 533-0012
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/21/2012
Last updated
08/21/2012
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