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NPI Code Detail

MEDICARE: STEPHEN RAY MARTELL LPC

MEDICARE: STEPHEN RAY MARTELL LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorLPC010016GA
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1528695285
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN RAY MARTELL LPC
Provider Business Mailing Address
First Line : 110 N BURR BLVD
Second Line :
City : KEWANEE
State : IL
Zip : 61443-2214
Country : US
Telephone Number : 309-852-5272
Fax Number : 309-854-5575
Provider Business Practice Location Address
First Line : 110 N BURR BLVD
Second Line :
City : KEWANEE
State : IL
Zip : 61443-2214
Country : US
Telephone Number : 309-852-5272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2020
Last Update Date : 09/16/2024

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Directions to “ STEPHEN RAY MARTELL LPC” Practice Location

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