Doctor Name: | MS. FELECIA LEE THACKREY |
NPI Number: | 1053575928 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180.006687 |
Business Practice Address: | 1905 Court St Kankakee, IL - 60901 |
Business Phone Number: | 8159332240 |
Business Fax Number: | |
Mailing Address: | 328 S Oak St, MANTENO |
State: | IL |
Postal Code: | 609501606 |
Phone Number: | 8154688600 |
Fax Number: | |
NPI Enumeration Date: | 07/10/2008 |
NPI Last Update Date: | 07/10/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180.006687 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |