Provider Demographics
NPI:1891486338
Name:WEBSTER, AMY (MA,MHP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MA,MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-1736
Mailing Address - Country:US
Mailing Address - Phone:618-783-4154
Mailing Address - Fax:
Practice Address - Street 1:405 S WHITTLE AVE
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2262
Practice Address - Country:US
Practice Address - Phone:618-392-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL261QM0801X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor