Provider Demographics
NPI:1699010447
Name:SALLEE, CHRISTINE ANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:SALLEE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 W RICHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-7112
Mailing Address - Country:US
Mailing Address - Phone:309-323-6645
Mailing Address - Fax:309-681-8139
Practice Address - Street 1:2610 W RICHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-7112
Practice Address - Country:US
Practice Address - Phone:309-323-6645
Practice Address - Fax:309-681-8139
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178.007032OtherLICENSED PROFESSIONAL COUNSELOR