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General NPI Number Information
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NPI Number | 1396426888
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Entity Type | Organization
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Legal Business Name | DAVID SHOR PH.D. LLC
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 5225 OLD ORCHARD RD STE 30
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City | SKOKIE
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State | IL
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Zip | 60077-1027
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Country | US
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Telephone | 847-331-2949
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Fax |
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Provider Business Mailing Address
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Address Line | 5225 OLD ORCHARD RD STE 30
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City | SKOKIE
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State | IL
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Zip | 60077-1027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID SHOR
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Credential | PH.D.
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Telephone | 847-331-2949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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