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Miss Kenyon Rena Douglass, LCPC
Professional Counselor in Chicago, Illinois
NPI 1215002050

Kenyon Rena Douglass is a Professional Counselor based in Chicago, IL and is specialized in Professional. Kenyon Rena Douglass practices in Chicago, IL and has the professional credentials of LCPC. The NPI Number for Kenyon Rena Douglass is 1215002050 and holds a License No. 180004106 (Illinois).

The current practice location address for Kenyon Rena Douglass is 1525 E 53Rd St, Chicago, IL and can be reached out via phone at 312-388-9182. You can also correspond with Kenyon Rena Douglass through the mailing address at 4518 S INDIANA AVE, CHICAGO, IL - 60653-3908 (mailing address contact number: 773-624-9878).

Location: 1525 E 53Rd St, Chicago, IL, 60653-3908
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Provider Profile Details
NPI Number
1215002050
Provider Name
Kenyon Rena Douglass
Credential
LCPC
Provider Entity Type
Individual
Gender
Female
Address
1525 E 53Rd St, Chicago, IL, 60653-3908
Phone Number
312-388-9182
Fax Number
Provider Enumeration Date
11/21/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
567052000 01 IL MAGELLAN HEALTH
1634163 01 IL BLUE CROSS BLUE SHIELD IL
institution
Provider Business Practice Location Address Details
Address
1525 E 53Rd St
City
State
Zip
60615-4557
Phone Number
312-388-9182
Fax Number
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Provider Business Mailing Address Details
Address
1525 E 53Rd St
City
State
Zip
60615-4557
Phone Number
312-388-9182
Fax Number
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Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
180004106 (Illinois)
Definition
Definition to come...
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