NPIMap

Organization Active NPI

Kris Maynard LCSW LTD

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • La Grange, IL
National Provider Identifier
1174163463
Registry record updated Jul 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
KRIS MAYNARD LCSW LTD
Doing business as
Stillpath Therapy and Associates
Practice address
1030 S la Grange Rd Ste 9
La Grange, IL 60525-2893
Phone
(708) 921-3639
Fax
(708) 588-1501
NPI assigned
Jan 14, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kristine Maynard, LCSWNPI 1215077011
Title
President
Phone
(708) 921-3639

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1030 S la Grange Rd Ste 9
La Grange, IL 60525-2893

Mailing address

1030 S la Grange Rd Ste 9
La Grange, IL 60525-2893
Phone (708) 921-3639

Other names 1

  • Stillpath Therapy and Associates Doing business as

National Provider Directory

National Provider Directory

Locations

1030 S La Grange Rd
Ste 9
La Grange, IL 60525
Phone (708) 808-4572

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625443200000",
    "number": "1174163463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 S LA GRANGE RD STE 9",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252893",
            "telephone_number": "708-921-3639",
            "fax_number": "708-588-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 S LA GRANGE RD STE 9",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252893",
            "telephone_number": "708-921-3639",
            "fax_number": "708-588-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRIS MAYNARD LCSW LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-14",
        "last_updated": "2021-07-05",
        "certification_date": "2021-07-05",
        "status": "A",
        "authorized_official_last_name": "MAYNARD",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-921-3639",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stillpath Therapy and Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Grange, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.