Provider Demographics
NPI:1639510167
Name:DR. SHANTELLE AND ASSOCIATES, LTD
Entity Type:Organization
Organization Name:DR. SHANTELLE AND ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-339-9832
Mailing Address - Street 1:552 S WASHINGTON ST STE 115
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6669
Mailing Address - Country:US
Mailing Address - Phone:312-339-9832
Mailing Address - Fax:630-857-9101
Practice Address - Street 1:552 S WASHINGTON ST STE 115
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6669
Practice Address - Country:US
Practice Address - Phone:312-339-9832
Practice Address - Fax:331-999-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty