Provider Demographics
NPI:1326374232
Name:SHUTAY, RENEE ANN (MA, LCPC)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ANN
Last Name:SHUTAY
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 1:13651 W CEDARBEND DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9111
Mailing Address - Country:US
Mailing Address - Phone:708-205-7709
Mailing Address - Fax:
Practice Address - Street 1:15915 S CRYSTAL CREEK DR
Practice Address - Street 2:UNIT E
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9284
Practice Address - Country:US
Practice Address - Phone:708-205-7709
Practice Address - Fax:708-301-8167
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006366101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional