Healthcare Provider Details

I. General information

NPI: 1609643212
Provider Name (Legal Business Name): LIFE STAGES COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24047 W LOCKPORT ST STE 201G
PLAINFIELD IL
60544-1680
US

IV. Provider business mailing address

310 DREWSBURY LN
ROMEOVILLE IL
60446-1784
US

V. Phone/Fax

Practice location:
  • Phone: 815-531-4556
  • Fax:
Mailing address:
  • Phone: 815-531-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier1982246294
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name: MR. LYNN BUCK
Title or Position: OWNER/COUNSELOR
Credential: LCPC
Phone: 815-531-4556