| Amy C Champion, Llc | |
|
1115 Frontage Rd Ste B O Fallon IL 62269-2093 | |
| (618) 792-5200 | |
| Not Available |
| Full Name | Amy C Champion, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1115 Frontage Rd Ste B, O Fallon, Illinois |
| Authorized Official Name and Position | Amy Champion (LICENSED CLINICAL PROFESSIONAL COUN) |
| Authorized Official Contact | 6187925200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy C Champion, Llc 1115 Frontage Rd Ste B O Fallon IL 62269-2093 Ph: (618) 792-5200 | Amy C Champion, Llc 1115 Frontage Rd Ste B O Fallon IL 62269-2093 Ph: (618) 792-5200 |
| NPI Number | 1508536939 |
|---|---|
| Provider Enumeration Date | 09/16/2021 |
| Last Update Date | 09/16/2021 |
| Certification Date | 09/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508536939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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