Provider Demographics
NPI:1578263000
Name:CANTRELL, VERNEST II (CRSS)
Entity Type:Individual
Prefix:
First Name:VERNEST
Middle Name:
Last Name:CANTRELL
Suffix:II
Gender:M
Credentials:CRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 HICKORY CREEK DR.
Mailing Address - Street 2:UNIT 2
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60484
Mailing Address - Country:US
Mailing Address - Phone:708-539-9250
Mailing Address - Fax:
Practice Address - Street 1:4331 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2404
Practice Address - Country:US
Practice Address - Phone:708-748-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor