Provider Demographics
NPI:1811537806
Name:TERRELL, STEPHANIE NICOLE (LCPC, BC-DMT)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LCPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W BELMONT AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3241
Mailing Address - Country:US
Mailing Address - Phone:773-880-1310
Mailing Address - Fax:
Practice Address - Street 1:1300 W BELMONT AVE STE 301
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3241
Practice Address - Country:US
Practice Address - Phone:773-880-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012542101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor