Provider Demographics
NPI:1790804995
Name:FENNELL, EVELYN L (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:L
Last Name:FENNELL
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 1:121 HIDDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4902
Mailing Address - Country:US
Mailing Address - Phone:847-381-8405
Mailing Address - Fax:847-381-8491
Practice Address - Street 1:121 HIDDEN OAKS DR
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4902
Practice Address - Country:US
Practice Address - Phone:847-331-7504
Practice Address - Fax:847-381-8491
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health