Maurice Lewis Anthony
Individual provider Active NPI Counselor · Benton, IL
NPI 1508514175 · NPPES record last updated Mar 14, 2022
Key facts
- NPI
- 1508514175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 904 E Main St
Benton, IL 62812-3030 - Phone
- (618) 937-6483
- Fax
- (618) 937-1440
- NPI assigned
- Mar 14, 2022
- Sex
- Male
- Sole proprietor
- No
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
904 E Main St
Benton, IL 62812-3030
Mailing address
902 W Main St
West Frankfort, IL 62896-2210
Phone (618) 937-6483
Other providers in Benton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.