=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831830777
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STOLTE PSYCHOLOGICAL SERVICES, PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2022
-----------------------------------------------------
Last Update Date | 04/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8121 N ELMORE ST
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60714-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-340-0889
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 481250
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60714-6247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-340-0889
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ALEX N STOLTE
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 630-340-0889
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------