Provider Demographics
NPI:1548698558
Name:GORENZ, SHELLEY (:LCPC LSW)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:GORENZ
Suffix:
Gender:F
Credentials::LCPC LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-2434
Mailing Address - Country:US
Mailing Address - Phone:815-876-6285
Mailing Address - Fax:815-875-1267
Practice Address - Street 1:1009 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356
Practice Address - Country:US
Practice Address - Phone:815-876-6285
Practice Address - Fax:815-875-1267
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional