Provider Demographics
NPI:1275767717
Name:HOWARD, QUEENA LOUISE (LCPC)
Entity Type:Individual
Prefix:MISS
First Name:QUEENA
Middle Name:LOUISE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 N IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-3054
Mailing Address - Country:US
Mailing Address - Phone:309-363-1400
Mailing Address - Fax:
Practice Address - Street 1:2111 N IDAHO ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-3054
Practice Address - Country:US
Practice Address - Phone:309-363-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007518101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional