Provider Demographics
NPI:1720891310
Name:SMITH, STEPHEN LYNN JR
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LYNN
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-1126
Mailing Address - Country:US
Mailing Address - Phone:312-383-4364
Mailing Address - Fax:
Practice Address - Street 1:2250 POINT BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7873
Practice Address - Country:US
Practice Address - Phone:224-802-8824
Practice Address - Fax:224-802-8879
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health