Nathan Lee Caron, MHP

Individual provider Active NPI Professional Counselor · Waterloo, IL

NPI 1407525702 · NPPES record last updated Dec 27, 2022

Key facts

NPI
1407525702
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
Practice address
988 N Illinois Route 3
Waterloo, IL 62298-1059
Phone
(618) 939-4444
NPI assigned
Sep 9, 2021
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Practitioner 225400000X
Professional Counselor 101YP2500X Yes

Addresses

Primary practice location

988 N Illinois Route 3
Waterloo, IL 62298-1059

Mailing address

988 N Illinois Route 3
Waterloo, IL 62298-1059
Phone (618) 939-4444

Other providers in Waterloo, IL

All providers in Waterloo, IL · Professional Counselor in Illinois

Sources for this page

Verify at the official NPI Registry.