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General NPI Number Information
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NPI Number | 1356648539
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Entity Type | Organization
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Legal Business Name | STACEY J. BEISEL, LCPC, P.C.
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | 60 S STATE ROUTE 157 SUITE 18
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3846
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Country | US
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Telephone | 618-580-5708
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Fax |
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Provider Business Mailing Address
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Address Line | 60 S STATE ROUTE 157 SUITE 18
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3846
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Country | US
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Telephone | 618-580-5708
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PROFESSIONAL COUN
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Name | STACEY J BEISEL
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Credential | MS
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Telephone | 618-580-5708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.1004316
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License Number State | IL
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