Healthcare Provider Details

I. General information

NPI: 1265020408
Provider Name (Legal Business Name): MISTY STRINGER BA MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 TROESTER RD
VILLA RIDGE IL
62996-2469
US

IV. Provider business mailing address

776 TROESTER RD
VILLA RIDGE IL
62996-2469
US

V. Phone/Fax

Practice location:
  • Phone: 618-306-3567
  • Fax:
Mailing address:
  • Phone: 618-306-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.028841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: