Provider Demographics
NPI:1396444683
Name:BRUNSWIG, CALLIE (LPC)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:BRUNSWIG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOOD HOPE
Mailing Address - State:IL
Mailing Address - Zip Code:61438-9161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 30TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6046
Practice Address - Country:US
Practice Address - Phone:309-764-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178018231101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional