Provider Demographics
NPI:1356648539
Name:STACEY J. BEISEL, LCPC, P.C.
Entity type:Organization
Organization Name:STACEY J. BEISEL, LCPC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:618-580-5708
Mailing Address - Street 1:60 S STATE ROUTE 157
Mailing Address - Street 2:SUITE 18
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3846
Mailing Address - Country:US
Mailing Address - Phone:618-580-5708
Mailing Address - Fax:
Practice Address - Street 1:60 S STATE ROUTE 157
Practice Address - Street 2:SUITE 18
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3846
Practice Address - Country:US
Practice Address - Phone:618-580-5708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.1004316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty