MEDICARE: STEADFAST CENTER LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1659855997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEADFAST CENTER LLC

Provider Business Mailing Address
First Line	:	1013 W WASHINGTON ST
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61821-2717
Country	:	US
Telephone Number	:	217-778-4134
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 W WASHINGTON ST
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61821-2717
Country	:	US
Telephone Number	:	217-778-4134
Fax Number	:	217-866-1355

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. HEATHER L PIERCE
Credential	:	LCPC
Telephone Number	:	217-778-4134

Provider Enumeration Date	:	09/22/2018
Last Update Date	:	08/01/2024

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Directions to “STEADFAST CENTER LLC ” Practice Location

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