Provider Demographics
NPI:1003503699
Name:SHIM, BYEOL
Entity type:Individual
Prefix:
First Name:BYEOL
Middle Name:
Last Name:SHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W LAKE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2565
Mailing Address - Country:US
Mailing Address - Phone:331-221-1650
Mailing Address - Fax:331-221-2710
Practice Address - Street 1:303 W LAKE ST STE 301
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2565
Practice Address - Country:US
Practice Address - Phone:331-221-1650
Practice Address - Fax:331-221-2710
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180015217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional