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General NPI Number Information
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NPI Number | 1306464201
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Entity Type | Organization
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Legal Business Name | STONE BRIDGE COUNSELING LLC
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 3526 N CALIFORNIA AVE STE 204
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City | PEORIA
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State | IL
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Zip | 61603-1164
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Country | US
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Telephone | 815-408-0522
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Fax |
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Provider Business Mailing Address
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Address Line | 418 W MICHIGAN AVE
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City | METAMORA
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State | IL
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Zip | 61548-9632
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Country | US
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Telephone | 309-251-9328
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MR. DANIEL RYNE OSTERLOO
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Credential | LCPC
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Telephone | 309-251-9328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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