Healthcare Provider Details

I. General information

NPI: 1396469896
Provider Name (Legal Business Name): S. BURBY MENTAL HEALTH CONSULTING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4749 LINCOLN MALL DR STE 202H PMB2048
MATTESON IL
60443-3826
US

IV. Provider business mailing address

4749 LINCOLN MALL DR STE 202H PMB2048
MATTESON IL
60443-3826
US

V. Phone/Fax

Practice location:
  • Phone: 708-252-3152
  • Fax:
Mailing address:
  • Phone: 708-252-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1558762724
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name: STEFANIE BURBY
Title or Position: OWNER
Credential: LCSW
Phone: 708-252-3152