=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003342783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STACEY SAMANTHA SOLIMAN JUILFS LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2017
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 639 YORK ST RM 212
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62301-3919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-222-6271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 E LAHARPE ST
-----------------------------------------------------
City | KIRKSVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63501-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-224-1210
-----------------------------------------------------
Fax | 636-246-1008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180013946
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2016040022
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------