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General NPI Number Information
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NPI Number | 1912267154
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Entity Type | Individual
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Provider Name | PAUL J SCHELLENBERG LCPC
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Gender | Male
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 12/13/2012
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Provider Practice Location Address
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Address Line | 3915 N SHERIDAN RD UNIT R
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City | PEORIA
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State | IL
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Zip | 61614-7135
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Country | US
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Telephone | 309-681-9432
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Fax | 309-681-9164
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Provider Business Mailing Address
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Address Line | 2915 N KNOXVILLE AVE
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City | PEORIA
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State | IL
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Zip | 61603
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Country | US
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Telephone | 309-696-0267
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Fax |
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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 | 180.006527
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License Number State | IL
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