Healthcare Provider Details

I. General information

NPI: 1528516440
Provider Name (Legal Business Name): STEPHANIE MCGUIRE BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 EDWARDS ST
NEWTON IL
62448-1736
US

IV. Provider business mailing address

106 EDWARDS ST
NEWTON IL
62448-1736
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-4154
  • Fax: 618-783-2339
Mailing address:
  • Phone: 618-783-4154
  • Fax: 618-783-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: