Provider Demographics
NPI:1326470121
Name:SCHWEDA, AMBER PHELPS (LCPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:PHELPS
Last Name:SCHWEDA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 N WATER TOWER PLACE, SUITE C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6295
Mailing Address - Country:US
Mailing Address - Phone:618-244-0212
Mailing Address - Fax:618-244-0535
Practice Address - Street 1:4114 N WATER TOWER PLACE, SUITE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6295
Practice Address - Country:US
Practice Address - Phone:618-244-0212
Practice Address - Fax:618-244-0535
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008725101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor