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General NPI Number Information
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NPI Number | 1154860567
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Entity Type | Organization
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Legal Business Name | STEPANIE EVANS LPCL INC
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 3139 N LINCOLN AVE STE 203
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City | CHICAGO
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State | IL
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Zip | 60657-3122
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Country | US
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Telephone | 773-717-2590
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Fax |
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Provider Business Mailing Address
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Address Line | 4125 W AINSLIE ST
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City | CHICAGO
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State | IL
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Zip | 60630-2814
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Country | US
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Telephone | 773-919-7079
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | STEPHANIE ANN EVANS
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Credential | LCPC
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Telephone | 773-919-7079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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