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General NPI Number Information
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NPI Number | 1124725411
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Entity Type | Organization
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Legal Business Name | JAMIE STEVENS COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 02/08/2023
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 1701 S PROSPECT AVE STE 101
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City | CHAMPAIGN
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State | IL
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Zip | 61820-7054
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Country | US
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Telephone | 217-621-8533
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 499
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City | SAVOY
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State | IL
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Zip | 61874-0499
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE STEVENS
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Credential | LCPC
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Telephone | 217-621-8533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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