=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225757529
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STILL OAK COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2022
-----------------------------------------------------
Last Update Date | 01/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3833 E MAIN ST # 1002
-----------------------------------------------------
City | ST CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60174-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-354-8705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3833 E MAIN ST # 1002
-----------------------------------------------------
City | ST CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60174-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-354-8705
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ELIZABETH BODETT-DRESSER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-354-8705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------