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General NPI Number Information
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NPI Number | 1548698558
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Entity Type | Individual
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Provider Name | SHELLEY GORENZ :LCPC LSW
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Gender | Female
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Dates
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Enumeration Date | 10/30/2013
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 1009 S. MAIN ST.
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City | PRINCETON
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State | IL
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Zip | 61356
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Country | US
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Telephone | 815-876-6285
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Fax | 815-875-1267
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Provider Business Mailing Address
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Address Line | 1009 S MAIN ST
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City | PRINCETON
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State | IL
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Zip | 61356-2434
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Country | US
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Telephone | 815-876-6285
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Fax | 815-875-1267
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180001089
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License Number State | IL
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