Provider Demographics
NPI:1861628679
Name:BEISEL, STACEY JEAN (LCPC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:JEAN
Last Name:BEISEL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 S STATE ROUTE 157 STE 18
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3899
Mailing Address - Country:US
Mailing Address - Phone:618-580-5708
Mailing Address - Fax:
Practice Address - Street 1:60 S STATE ROUTE 157 STE 18
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3899
Practice Address - Country:US
Practice Address - Phone:618-580-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007620101YM0800X
IL178.005542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health