Healthcare Provider Details

I. General information

NPI: 1851684625
Provider Name (Legal Business Name): STEPHEN M WRIGHT MA, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 LIBERTY GROVE DR.
WILLOW SPRINGS IL
60480
US

IV. Provider business mailing address

8615 LIBERTY GROVE DR.
WILLOW SPRINGS IL
60480
US

V. Phone/Fax

Practice location:
  • Phone: 708-232-8876
  • Fax:
Mailing address:
  • Phone: 708-785-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178006958
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: