Provider Demographics
NPI:1912235789
Name:STAVSKIENE, LORETA (MS, LCPC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LORETA
Middle Name:
Last Name:STAVSKIENE
Suffix:
Gender:F
Credentials:MS, LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1072
Mailing Address - Country:US
Mailing Address - Phone:630-935-8568
Mailing Address - Fax:
Practice Address - Street 1:684 W BOUGHTON RD STE 103
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1781
Practice Address - Country:US
Practice Address - Phone:630-809-1441
Practice Address - Fax:888-409-5760
Is Sole Proprietor?:No
Enumeration Date:2009-12-06
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002233A101YM0800X
IL180007075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health