Healthcare Provider Details

I. General information

NPI: 1366700155
Provider Name (Legal Business Name): ROBERT PRESTON STANFORD LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20015 S LA GRANGE RD # 1067
FRANKFORT IL
60423-3104
US

IV. Provider business mailing address

20015 S LA GRANGE RD # 1067
FRANKFORT IL
60423-3104
US

V. Phone/Fax

Practice location:
  • Phone: 708-678-1324
  • Fax:
Mailing address:
  • Phone: 708-678-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: