Provider Demographics
NPI:1932840378
Name:TUNNEY, STEPHANIE KRISTINE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KRISTINE
Last Name:TUNNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15915 S CRYSTAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9284
Mailing Address - Country:US
Mailing Address - Phone:708-529-6976
Mailing Address - Fax:
Practice Address - Street 1:15915 S CRYSTAL CREEK DR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9284
Practice Address - Country:US
Practice Address - Phone:708-529-6976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017318103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling