Active NPI
Stephen Maurice Edfors, LCPC, CADC
- Professional Counselor
- Chicago, IL
National Provider Identifier
1972632131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.003641
- Practice address
- 845 S Damen Ave
Chicago, IL 60612-3727 - Phone
- (773) 319-4007
- Fax
- (773) 319-4007
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.003641 | IL | Primary |
Addresses
Primary practice location
845 S Damen Ave
Chicago, IL 60612-3727
Mailing address
4734 N Kenmore Ave
Chicago, IL 60640-5016
Phone (773) 319-4007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.003641 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394582400000",
"number": "1972632131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4734 N KENMORE AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606405016",
"telephone_number": "773-319-4007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "845 S DAMEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123727",
"telephone_number": "773-319-4007",
"fax_number": "773-319-4007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDFORS",
"first_name": "STEPHEN",
"middle_name": "MAURICE",
"name_prefix": "Mr.",
"credential": "LCPC, CADC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2014-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.003641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.