Provider Demographics
NPI:1093078099
Name:HILL, SHELLEY LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LYNN
Last Name:HILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 100
Mailing Address - Street 2:GOYA HEALTH, LTD.
Mailing Address - City:ENERGY
Mailing Address - State:IL
Mailing Address - Zip Code:62933
Mailing Address - Country:US
Mailing Address - Phone:618-988-9843
Mailing Address - Fax:618-942-8640
Practice Address - Street 1:202 S. PERSHING ST.
Practice Address - Street 2:GOYA HEALTH LTD.
Practice Address - City:ENERGY
Practice Address - State:IL
Practice Address - Zip Code:62933
Practice Address - Country:US
Practice Address - Phone:618-988-9843
Practice Address - Fax:618-942-8640
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.009.0061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical