Healthcare Provider Details

I. General information

NPI: 1700990934
Provider Name (Legal Business Name): CHRISTINE KATHLEEN STANOCH LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 W. 159TH ST. THE GENESIS THERAPY CENTER BLDG C
OAK FOREST IL
60452
US

IV. Provider business mailing address

5525 KING ARTHUR CT APT. 11
WESTMONT IL
60559-5809
US

V. Phone/Fax

Practice location:
  • Phone: 708-535-7320
  • Fax: 708-535-7571
Mailing address:
  • Phone: 708-535-7320
  • Fax: 708-535-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: