=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639057128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN STANCIL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2025
-----------------------------------------------------
Last Update Date | 08/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 N MAIN ST
-----------------------------------------------------
City | LA PORTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46350-6074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-380-7879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 222
-----------------------------------------------------
City | KINGSBURY
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46345-0222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-380-7879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 4007759A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 4007759A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 4007759A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------