Provider Demographics
NPI:1346840295
Name:STOPKA PROFESSIONAL COUNSELING LLC
Entity Type:Organization
Organization Name:STOPKA PROFESSIONAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STOPKA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-517-6520
Mailing Address - Street 1:2501 CHATHAM RD STE R
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4188
Mailing Address - Country:US
Mailing Address - Phone:773-517-6520
Mailing Address - Fax:
Practice Address - Street 1:13125 STEEPLECHASE DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1320
Practice Address - Country:US
Practice Address - Phone:773-517-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)