Individual
CISSI MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4110 N WATER TOWER PL, MOUNT VERNON, IL 62864-6295
(618) 242-8266
Mailing address
150 JUNIPER DR, MOUNT VERNON, IL 62864-5942
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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