Provider Demographics
NPI:1003342783
Name:JUILFS, STACEY SAMANTHA SOLIMAN (LPC)
Entity Type:Individual
Prefix:
First Name:STACEY SAMANTHA
Middle Name:SOLIMAN
Last Name:JUILFS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:STACEY SAMANTHA
Other - Middle Name:SAHAGUN
Other - Last Name:SOLIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 OLD SOUTH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4120
Mailing Address - Country:US
Mailing Address - Phone:636-224-1210
Mailing Address - Fax:636-246-1008
Practice Address - Street 1:639 YORK ST RM 212
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3919
Practice Address - Country:US
Practice Address - Phone:217-222-6271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016040022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional