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General NPI Number Information
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NPI Number | 1497276331
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Entity Type | Individual
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Provider Name | STEPHANIE COUTTS
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Gender | Female
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 125 FAIRFIELD WAY STE 290
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1598
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Country | US
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Telephone | 630-440-5406
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Fax |
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Provider Business Mailing Address
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Address Line | 125 FAIRFIELD WAY STE 290
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1598
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 178.012872
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License Number State | IL
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