Provider Demographics
NPI:1982825022
Name:RENNELS, CASSIE CAPRICE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:CAPRICE
Last Name:RENNELS
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 1:9310 APRIL LN
Mailing Address - Street 2:
Mailing Address - City:ASHMORE
Mailing Address - State:IL
Mailing Address - Zip Code:61912-9123
Mailing Address - Country:US
Mailing Address - Phone:217-348-8150
Mailing Address - Fax:217-348-8150
Practice Address - Street 1:9310 APRIL LN
Practice Address - Street 2:
Practice Address - City:ASHMORE
Practice Address - State:IL
Practice Address - Zip Code:61912-9123
Practice Address - Country:US
Practice Address - Phone:217-348-8150
Practice Address - Fax:217-348-8150
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional