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General NPI Number Information
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NPI Number | 1952780264
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Entity Type | Organization
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Legal Business Name | SHEADE PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 4411 N RAVENSWOOD AVE STE 200
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City | CHICAGO
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State | IL
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Zip | 60640-5802
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Country | US
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Telephone | 773-999-9987
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Fax | 847-868-8614
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Provider Business Mailing Address
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Address Line | 4411 N RAVENSWOOD AVE STE 200
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City | CHICAGO
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State | IL
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Zip | 60640-5802
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Country | US
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Telephone | 773-999-9987
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Fax | 847-780-3360
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | ALLISON K. SHEADE
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Credential | LCPC
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Telephone | 773-999-9987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180009684
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License Number State | IL
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