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General NPI Number Information
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NPI Number | 1982255592
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Entity Type | Individual
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Provider Name | TAMELA STACY POLANIN LCPC
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Gender | Female
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 11/28/2024
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Provider Practice Location Address
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Address Line | 1703 W FLETCHER ST
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City | VANDALIA
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State | IL
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Zip | 62471-3117
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Country | US
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Telephone | 618-283-8750
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Fax |
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Provider Business Mailing Address
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Address Line | 2339 N 2000 ST
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City | SAINT ELMO
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State | IL
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Zip | 62458-4175
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Country | US
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Telephone | 618-292-7373
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.012372
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License Number State | IL
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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 | 180.012372
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License Number State | IL
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