Ebony Waller, LMFT, RPT, PHD
Individual provider Active NPI Marriage & Family Therapist · Cherry Valley, IL
NPI 1982431094 · NPPES record last updated Sep 14, 2024
Key facts
- NPI
- 1982431094
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 166.001541 (IL)
- Practice address
- 7572 N Cherryvale Blvd Apt 204
Cherry Valley, IL 61016-9305 - Phone
- (702) 572-8535
- NPI assigned
- Sep 14, 2024
- Sex
- Female
- 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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 166.001541 | IL | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 166.001541 | IL | Yes |
Addresses
Primary practice location
7572 N Cherryvale Blvd Apt 204
Cherry Valley, IL 61016-9305
Mailing address
7572 N Cherryvale Blvd Apt 204
Cherry Valley, IL 61016-9305
Phone (702) 572-8535
Other providers in Cherry Valley, IL
All providers in Cherry Valley, IL · Marriage & Family Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2024. 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.