Provider Demographics
NPI:1265659221
Name:STELLING, FREDRICK O JR (MA LCP)
Entity Type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:O
Last Name:STELLING
Suffix:JR
Gender:M
Credentials:MA LCP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1201 SOUTH MAIN STREET
Mailing Address - Street 2:P O BOX 400
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62651-0400
Mailing Address - Country:US
Mailing Address - Phone:217-479-2300
Mailing Address - Fax:217-479-2305
Practice Address - Street 1:1201 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62651-0400
Practice Address - Country:US
Practice Address - Phone:217-479-2300
Practice Address - Fax:217-479-2305
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical