Provider Demographics
NPI:1225303910
Name:ST. CLAIR, RENEE ANN (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:ANN
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W. SPRINGFIELD AVE.
Mailing Address - Street 2:SUITE 1005-1006
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820
Mailing Address - Country:US
Mailing Address - Phone:217-693-4918
Mailing Address - Fax:217-531-4047
Practice Address - Street 1:201 W. SPRINGFIELD AVE.
Practice Address - Street 2:SUITE 1005-1006
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820
Practice Address - Country:US
Practice Address - Phone:217-693-4918
Practice Address - Fax:217-531-4047
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1225303910Medicaid
IL1538561691Medicaid