Provider Demographics
NPI:1053637827
Name:MCCALL, YVONNE M (MA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:M
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1237
Mailing Address - Country:US
Mailing Address - Phone:618-656-9208
Mailing Address - Fax:
Practice Address - Street 1:671 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1237
Practice Address - Country:US
Practice Address - Phone:618-656-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001614101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional