MEDICARE: STACEY GRIFFITH LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	178012424	IL
2	101YP2500X	Professional Counselor	180.012687	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	178012424	OTHER	IL	LICENSE
2	8089-125	OTHER	WI	WI LICENSE
3	180.012687	OTHER	IL	LICENSE

General Provider Information

NPI Number	:	1578069506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY GRIFFITH LCPC

Provider Business Mailing Address
First Line	:	3205 N WILKE RD STE 102C
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-0004
Country	:	US
Telephone Number	:	224-349-2594
Fax Number	:	224-850-3500

Provider Business Practice Location Address
First Line	:	3205 N WILKE RD STE 102C
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-0004
Country	:	US
Telephone Number	:	224-349-2594
Fax Number	:	224-850-3500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	06/13/2022

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