Provider Demographics
NPI:1053574798
Name:MEIS, STEPHANIE GOLDMAN (MA LCPC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:GOLDMAN
Last Name:MEIS
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 ST JOHNS AVE #400
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4649
Mailing Address - Country:US
Mailing Address - Phone:847-609-0406
Mailing Address - Fax:847-412-1434
Practice Address - Street 1:735 SAINT JOHNS AVE # 400
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4649
Practice Address - Country:US
Practice Address - Phone:847-609-0406
Practice Address - Fax:847-412-1434
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.006342OtherILLINOIS COUNSELING LICENSE