Provider Demographics
NPI:1467134197
Name:NIEBUR, CARA WELLS (LPC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:WELLS
Last Name:NIEBUR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:LYNN
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 N MELVIN ST
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1477
Mailing Address - Country:US
Mailing Address - Phone:217-784-4251
Mailing Address - Fax:
Practice Address - Street 1:417 HAGER DR
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1040
Practice Address - Country:US
Practice Address - Phone:217-784-2146
Practice Address - Fax:217-784-1327
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional