Provider Demographics
NPI:1013061639
Name:SHEAR, MICHAEL S (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:SHEAR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 FULTON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1274
Mailing Address - Country:US
Mailing Address - Phone:309-673-9385
Mailing Address - Fax:309-673-9446
Practice Address - Street 1:456 FULTON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1274
Practice Address - Country:US
Practice Address - Phone:309-673-9385
Practice Address - Fax:309-673-9446
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional