Provider Demographics
NPI:1982044889
Name:STOUFFER CLINICAL COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:STOUFFER CLINICAL COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:217-415-1739
Mailing Address - Street 1:900 CAPITAL AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-8410
Mailing Address - Country:US
Mailing Address - Phone:217-415-1739
Mailing Address - Fax:
Practice Address - Street 1:900 CAPITAL AIRPORT DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62707-8410
Practice Address - Country:US
Practice Address - Phone:217-415-1739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL248000699251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health