Provider Demographics
NPI:1760644017
Name:VENTURI, MICHELLE R (LCSW CADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:VENTURI
Suffix:
Gender:F
Credentials:LCSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 LINCOLNSHIRE DR STE D
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2189
Mailing Address - Country:US
Mailing Address - Phone:618-242-4205
Mailing Address - Fax:618-242-4209
Practice Address - Street 1:4230 LINCOLNSHIRE DR STE D
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2189
Practice Address - Country:US
Practice Address - Phone:618-242-4205
Practice Address - Fax:618-242-4209
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25196101YA0400X
IL149 0129581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)