Healthcare Provider Details

I. General information

NPI: 1972657732
Provider Name (Legal Business Name): JULIE E SELLNER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 LOURDES RD
METAMORA IL
61548-7609
US

IV. Provider business mailing address

1431 LOURDES RD
METAMORA IL
61548-7609
US

V. Phone/Fax

Practice location:
  • Phone: 309-383-4323
  • Fax: 309-383-4323
Mailing address:
  • Phone: 309-383-4323
  • Fax: 309-383-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number180.005723
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number180.005723
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: