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General NPI Number Information
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NPI Number | 1629402698
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Entity Type | Organization
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Legal Business Name | GORENZ COUNSELING AND CONSULTING LTD
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 08/27/2013
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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 | 61356-2434
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Country | US
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Telephone | 815-872-2273
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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 | 815-872-2273
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Fax | 815-875-1267
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MRS. SHELLEY JEAN GORENZ
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Credential | LCPC
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Telephone | 815-876-6285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4271
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149002582
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License Number State | IL
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Taxonomy #3
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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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