Healthcare Provider Details

I. General information

NPI: 1184539678
Provider Name (Legal Business Name): SPOON RIVER COUNSELING & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E ELM ST
CANTON IL
61520-2759
US

IV. Provider business mailing address

410 E ELM ST
CANTON IL
61520-2759
US

V. Phone/Fax

Practice location:
  • Phone: 309-740-2171
  • Fax:
Mailing address:
  • Phone: 309-740-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA STELIGA-PHILLIPS
Title or Position: CO-OWNER
Credential: PSYD
Phone: 309-740-2171