Provider Demographics
NPI:1609477579
Name:SUTTON-MCKENZIE, SHANTRELL PATRICE (LPC, NCC)
Entity type:Individual
Prefix:MISS
First Name:SHANTRELL
Middle Name:PATRICE
Last Name:SUTTON-MCKENZIE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22910 BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-2302
Mailing Address - Country:US
Mailing Address - Phone:312-566-3881
Mailing Address - Fax:
Practice Address - Street 1:5042 W ERIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-1604
Practice Address - Country:US
Practice Address - Phone:773-208-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016427101YP2500X
IL18015878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional