Healthcare Provider Details

I. General information

NPI: 1053529941
Provider Name (Legal Business Name): BURNELL K STEELMAN L.C.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MAPLE DR
CATLIN IL
61817-9203
US

IV. Provider business mailing address

302 MAPLE DR
CATLIN IL
61817-9203
US

V. Phone/Fax

Practice location:
  • Phone: 217-260-9396
  • Fax:
Mailing address:
  • Phone: 217-260-9396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180006891
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006891
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: