Healthcare Provider Details

I. General information

NPI: 1114542040
Provider Name (Legal Business Name): STACI E. ZERPHEY LCPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 LAKE ST STE 425
OAK PARK IL
60301-1163
US

IV. Provider business mailing address

1011 LAKE ST STE 425
OAK PARK IL
60301-1163
US

V. Phone/Fax

Practice location:
  • Phone: 312-870-0120
  • Fax: 312-819-2080
Mailing address:
  • Phone: 312-870-0120
  • Fax: 312-819-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number18-487
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.013734
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: