Stephanie Pitt, RDN, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

178.021619 Issued in IL

Practice address

904 E Martin Luther King Drive
Centralia, IL 62801-3058

Phone

(618) 533-1391

NPI assigned

Aug 14, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1471132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750118400000",
    "number": "1871047217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 N 11TH ST",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622301013",
            "telephone_number": "618-541-5488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 E MARTIN LUTHER KING DRIVE",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013058",
            "telephone_number": "618-533-1391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "370 N 11th St",
            "address_purpose": "LOCATION",
            "city": "Breese",
            "state": "IL",
            "postal_code": "622301013",
            "country_code": "US",
            "telephone_number": "618-541-5488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PITT",
        "first_name": "STEPHANIE",
        "credential": "RDN, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-14",
        "last_updated": "2025-06-17",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.005608",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2006000506",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178.021619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871047217",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Physician Services Corp of Southern Illinois (St marys good samaritan medical group)
• Physician Services Corporation of Southern Illinois Inc (St. Mary's Good Samaritan Medical Group)
• Physician Services Corporation of Southern Illinois Inc (SSM Health Medical Group)
• Janna Pierce
• Pinckneyville Healthcare Center LLC
• Jessica Plant
• Shaun James Poehler, D.C.
• Stefanie Poettker
• Kaleigh Price
• Progressive Life Counseling LLC

• Mental Health Counselor in Centralia, IL
• Providers in Centralia, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; 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.