Provider Demographics
NPI:1760772974
Name:POLEY, JENEAN (LCPC)
Entity Type:Individual
Prefix:
First Name:JENEAN
Middle Name:
Last Name:POLEY
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 1:20347 N MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3617
Mailing Address - Country:US
Mailing Address - Phone:810-877-5532
Mailing Address - Fax:
Practice Address - Street 1:20347 N MEADOW LN
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:IL
Practice Address - Zip Code:60010-3617
Practice Address - Country:US
Practice Address - Phone:810-877-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional