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Mr. Coleman Riley Vizcarra
Mental Health Counselor in Centralia, Illinois
NPI 1770831893

Coleman Riley Vizcarra is a Mental Health Counselor based in Centralia, IL and is specialized in Mental Health. Coleman Riley Vizcarra practices in Centralia, IL. The NPI Number for Coleman Riley Vizcarra is 1770831893 and holds a License No. (Illinois).

The current practice location address for Coleman Riley Vizcarra is 904 E. Martin Luther King Dr., Centralia, IL and can be reached out via phone at 618-533-1391 and via fax at 618-533-0012.

Location: 904 E. Martin Luther King Dr., Centralia, IL, 62801
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1770831893
Provider Name
Coleman Riley Vizcarra
Credential
Provider Entity Type
Individual
Gender
Male
Address
904 E. Martin Luther King Dr., Centralia, IL, 62801
Phone Number
618-533-1391
Fax Number
618-533-0012
Provider Enumeration Date
08/21/2012
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
904 E. Martin Luther King Dr.
City
Centralia
State
Illinois
Zip
62801
Phone Number
618-533-1391
Fax Number
618-533-0012
person
Provider Business Mailing Address Details
Address
904 E. Martin Luther King Dr.
City
Centralia
State
Illinois
Zip
62801
Phone Number
618-533-1391
Fax Number
618-533-0012
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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