Provider Demographics
NPI:1033544374
Name:TSU, SHANSHAN Y (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:SHANSHAN
Middle Name:Y
Last Name:TSU
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:SHANNAN
Other - Middle Name:
Other - Last Name:TSU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:610 W ROOSEVELT RD STE B1
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2303
Mailing Address - Country:US
Mailing Address - Phone:630-462-3999
Mailing Address - Fax:630-462-0911
Practice Address - Street 1:610 W ROOSEVELT RD STE B1
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2303
Practice Address - Country:US
Practice Address - Phone:630-462-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional