Provider Demographics
NPI:1376924696
Name:SHEA, RENEE A (LMFT, CADC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:A
Last Name:SHEA
Suffix:
Gender:F
Credentials:LMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 E BUTTERFIELD RD STE 310-5
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5618
Mailing Address - Country:US
Mailing Address - Phone:630-426-9279
Mailing Address - Fax:
Practice Address - Street 1:477 E BUTTERFIELD RD STE 310-5
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5618
Practice Address - Country:US
Practice Address - Phone:630-426-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30982101YA0400X
IL166000977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)