Provider Demographics
NPI:1720611122
Name:WALLACE-BELL, TENILLE TENILLE (LPC)
Entity type:Individual
Prefix:
First Name:TENILLE
Middle Name:TENILLE
Last Name:WALLACE-BELL
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 1:5209 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1525
Mailing Address - Country:US
Mailing Address - Phone:773-791-4918
Mailing Address - Fax:
Practice Address - Street 1:11952 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1167
Practice Address - Country:US
Practice Address - Phone:773-791-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health