Provider Demographics
NPI:1306852835
Name:SHEA, TIM (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:
Last Name:SHEA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-3108
Mailing Address - Country:US
Mailing Address - Phone:217-649-9076
Mailing Address - Fax:217-344-4733
Practice Address - Street 1:507 W SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3108
Practice Address - Country:US
Practice Address - Phone:217-649-9076
Practice Address - Fax:217-344-4733
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical