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General NPI Number Information
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NPI Number | 1528721909
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Entity Type | Individual
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Provider Name | TYRA FERRELL STEVERSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 18141 DIXIE HWY STE 202
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City | HOMEWOOD
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State | IL
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Zip | 60430-2243
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Country | US
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Telephone | 309-490-4853
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Fax |
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Provider Business Mailing Address
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Address Line | 18141 DIXIE HWY STE 202
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City | HOMEWOOD
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State | IL
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Zip | 60430-2243
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Country | US
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Telephone | 309-490-4853
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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 | 180.013951
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License Number State | IL
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