Judy, David

Judy, David is an individual health care provider with primary practice located at 504 Micah Drive Drawer M, Olney IL 62450-0913. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Judy, David can be contacted via phone (618) 395-4306.

Contact Information

Primary practice address
504 Micah Drive Drawer M Olney IL 62450-0913
Phone: (618) 395-4306
Fax: (618) 395-4507
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 180004995 Illinois
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1679761399
LBN Legal business name Judy, David
Credentials LCPC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 9th, 2007
Last updated Nov 15th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679761399 NPPES
Illinois Other 180004995 LCPC

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