MEDICARE: STOUFFER CLINICAL COUNSELING & CONSULTING 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	251S00000X	Community/Behavioral Health Agency	248000699	IL

General Provider Information

NPI Number	:	1982044889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOUFFER CLINICAL COUNSELING & CONSULTING LLC

Provider Business Mailing Address
First Line	:	900 CAPITAL AIRPORT DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62707-8410
Country	:	US
Telephone Number	:	217-415-1739
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 CAPITAL AIRPORT DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62707-8410
Country	:	US
Telephone Number	:	217-415-1739
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	MR. KEVIN R STOUFFER
Credential	:	LCPC
Telephone Number	:	217-415-1739

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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