Provider Demographics
NPI:1780222992
Name:WEYHRICH, AMBER L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:WEYHRICH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7058 QUAIL RUN RD
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:IL
Mailing Address - Zip Code:62849-1218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4114 N WATER TOWER PL STE F
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6548
Practice Address - Country:US
Practice Address - Phone:618-316-7058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-014988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional