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General NPI Number Information
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NPI Number | 1932614302
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Entity Type | Individual
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Provider Name | SHELBY MAILHO PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 4170 N MARINE DR APT 8F
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City | CHICAGO
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State | IL
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Zip | 60613-2303
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Country | US
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Telephone | 773-234-2881
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Fax | 872-678-8434
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Provider Business Mailing Address
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Address Line | 4170 N MARINE DR APT 8F
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City | CHICAGO
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State | IL
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Zip | 60613-2303
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Country | US
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Telephone | 773-234-2881
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Fax | 872-678-8434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.009674
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License Number State | IL
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