Provider Demographics
NPI:1942345335
Name:PASMA, SHELLEY J (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:J
Last Name:PASMA
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31162 N. BOB-O-LINK LANE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048
Mailing Address - Country:US
Mailing Address - Phone:847-362-1224
Mailing Address - Fax:847-918-1033
Practice Address - Street 1:800 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3254
Practice Address - Country:US
Practice Address - Phone:847-362-1224
Practice Address - Fax:847-918-1033
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3948125101YP2500X, 101YM0800X
WI394825101YA0400X
IL180001462101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health