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111 E Church St Mascoutah IL 62258-2110 | |
| (618) 566-3100 | |
| (618) 551-2233 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 111 E Church St, Mascoutah, Illinois |
| Authorized Official Name and Position | Stacy Stein (OWNER/ LCPC) |
| Authorized Official Contact | 6185663100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
111 E Church St Mascoutah IL 62258-2110 Ph: (618) 566-3100 | 111 E Church St Mascoutah IL 62258-2110 Ph: (618) 566-3100 |
| NPI Number | 1730542499 |
|---|---|
| Provider Enumeration Date | 03/31/2016 |
| Last Update Date | 03/31/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730542499 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180006373 (Illinois) | Primary |
| 101YP2500X | Counselor - Professional | 180010102 (Illinois) | Secondary |
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