Provider Demographics
NPI:1639057128
Name:STANCIL, ANN
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:STANCIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:KINGSBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46345-0222
Mailing Address - Country:US
Mailing Address - Phone:219-380-7879
Mailing Address - Fax:
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-6074
Practice Address - Country:US
Practice Address - Phone:219-380-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN4007759A101YA0400X, 101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health