Provider Demographics
NPI:1023554821
Name:YEHUDAH, SHOSHANAH BAHT (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SHOSHANAH
Middle Name:BAHT
Last Name:YEHUDAH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18220 HARWOOD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2151
Mailing Address - Country:US
Mailing Address - Phone:708-395-6083
Mailing Address - Fax:
Practice Address - Street 1:18220 HARWOOD AVE STE 5
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2151
Practice Address - Country:US
Practice Address - Phone:708-395-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180010743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health