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General NPI Number Information
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NPI Number | 1366214611
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Entity Type | Organization
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Legal Business Name | STILLWATER COUNSELING AND COACHING LLC
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 6912 MAIN ST STE 123
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-3440
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Country | US
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Telephone | 630-880-8903
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Fax |
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Provider Business Mailing Address
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Address Line | 310 MARIA CT
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City | MINOOKA
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State | IL
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Zip | 60447-9359
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Country | US
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Telephone | 630-880-8903
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | THERESA BURBACK
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Credential | LCPC
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Telephone | 630-880-8903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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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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