Healthcare Provider Details

I. General information

NPI: 1477231884
Provider Name (Legal Business Name): SANNA STELLA LCPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 WISCONSIN AVE
OAK PARK IL
60304-1043
US

IV. Provider business mailing address

827 WISCONSIN AVE
OAK PARK IL
60304-1043
US

V. Phone/Fax

Practice location:
  • Phone: 464-245-5656
  • Fax:
Mailing address:
  • Phone: 464-245-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.017722
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.017722
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: