Provider Demographics
NPI:1124663208
Name:ANNE WEATHERLY COUNSELING LLC
Entity type:Organization
Organization Name:ANNE WEATHERLY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WEATHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-838-7586
Mailing Address - Street 1:1224 TOWANDA AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7414
Mailing Address - Country:US
Mailing Address - Phone:309-838-7586
Mailing Address - Fax:
Practice Address - Street 1:1224 TOWANDA AVE STE 22
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7414
Practice Address - Country:US
Practice Address - Phone:309-838-7586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty