Healthcare Provider Details

I. General information

NPI: 1851178719
Provider Name (Legal Business Name): STEVEN MESMER & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/17/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PYOTT RD STE 102
CRYSTAL LAKE IL
60014-8717
US

IV. Provider business mailing address

190 HOLLOW WAY
INGLESIDE IL
60041-8777
US

V. Phone/Fax

Practice location:
  • Phone: 815-444-9076
  • Fax: 815-444-9079
Mailing address:
  • Phone: 815-444-9076
  • Fax: 815-444-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEVEN A MESMER
Title or Position: OWNER
Credential: MA
Phone: 815-444-9076