Provider Demographics
NPI:1962540716
Name:STALKER, ALICIA ANNE (LMFT)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:ANNE
Last Name:STALKER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ANNE
Other - Last Name:GALLICHIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:105 E MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-2149
Mailing Address - Country:US
Mailing Address - Phone:815-322-3238
Mailing Address - Fax:708-827-0454
Practice Address - Street 1:12400 S HARLEM AVE
Practice Address - Street 2:200
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1440
Practice Address - Country:US
Practice Address - Phone:708-250-2027
Practice Address - Fax:815-710-5100
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42067106H00000X
IL166.001066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-5218420OtherEIN