Basic Information
| Provider Information | |||||||||
| NPI: | 1790853265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCQUEEN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 E WERNSING AVE | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624014028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172346405 | ||||||||
| FaxNumber: | 2172586136 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 CHARLESTON AVE | ||||||||
| Address2: | |||||||||
| City: | MATTOON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619384016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172346405 | ||||||||
| FaxNumber: | 2172586136 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.