MEDICARE: STONEBRIDGE PSYCHOLOGICAL GROUP, PLLC

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1861324386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEBRIDGE PSYCHOLOGICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	3513 N OPAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-3029
Country	:	US
Telephone Number	:	773-679-9144
Fax Number	:

Provider Business Practice Location Address
First Line	:	3513 N OPAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-3029
Country	:	US
Telephone Number	:	773-679-9144
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	DR. STEPHEN WILLIAM BRYANT
Credential	:	PSYD, LCPC
Telephone Number	:	773-679-9144

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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