Healthcare Provider Details

I. General information

NPI: 1114582277
Provider Name (Legal Business Name): KEVIN RUSSELL STIER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2019
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE STE 1400
CHICAGO IL
60601-4011
US

IV. Provider business mailing address

850 W MARGATE TER APT 300
CHICAGO IL
60640-3980
US

V. Phone/Fax

Practice location:
  • Phone: 312-815-9660
  • Fax: 312-235-1999
Mailing address:
  • Phone: 313-407-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016432
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: