Provider Demographics
NPI:1659495802
Name:STRETCH, ROBERT WARREN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WARREN
Last Name:STRETCH
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 N UNIVERSITY ST
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4781
Mailing Address - Country:US
Mailing Address - Phone:309-693-3711
Mailing Address - Fax:309-692-7779
Practice Address - Street 1:5016 N UNIVERSITY ST
Practice Address - Street 2:SUITE # 103
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4781
Practice Address - Country:US
Practice Address - Phone:309-693-3711
Practice Address - Fax:309-692-7779
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health