Healthcare Provider Details

I. General information

NPI: 1659117240
Provider Name (Legal Business Name): STACIE LYNNE HOOVER ED.D, IMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 LANTERN LIGHTS CIR
LEBANON IL
62254-1842
US

IV. Provider business mailing address

1317 LANTERN LIGHTS CIR
LEBANON IL
62254-1842
US

V. Phone/Fax

Practice location:
  • Phone: 618-920-6245
  • Fax:
Mailing address:
  • Phone: 618-920-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: