Doctor Name: | MRS. RENEE ANN SHUTAY |
NPI Number: | 1326374232 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., L.C.P.C. |
License Number: | 180006366 |
Business Practice Address: | 15915 S Crystal Creek Dr Unit E Homer Glen, IL - 604919284 |
Business Phone Number: | 7082057709 |
Business Fax Number: | 7083018167 |
Mailing Address: | 13651 W Cedarbend Dr, HOMER GLEN |
State: | IL |
Postal Code: | 604919111 |
Phone Number: | 7082057709 |
Fax Number: | |
NPI Enumeration Date: | 10/27/2009 |
NPI Last Update Date: | 10/27/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180006366 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |