Provider Demographics
NPI:1861668006
Name:RENFREE, KATHLEEN S (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:RENFREE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15915 CRYSTAL CREEK DR UNIT E
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9381
Mailing Address - Country:US
Mailing Address - Phone:708-927-6649
Mailing Address - Fax:
Practice Address - Street 1:15915 CRYSTAL CREEK DR UNIT E
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9381
Practice Address - Country:US
Practice Address - Phone:708-927-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007495101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional