Provider Demographics
NPI:1831456995
Name:MEYERS, STEPHEN CHRISTINE (LCPC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHRISTINE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4205
Mailing Address - Country:US
Mailing Address - Phone:312-925-8086
Mailing Address - Fax:
Practice Address - Street 1:636 CHURCH ST STE 619A
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4586
Practice Address - Country:US
Practice Address - Phone:312-925-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009056101YP2500X
IL178.005484101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral