Provider Demographics
NPI:1205344173
Name:SHAMARI MENTORING COMPANY
Entity type:Organization
Organization Name:SHAMARI MENTORING COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLABODE
Authorized Official - Middle Name:OLUWOLE
Authorized Official - Last Name:OBAFEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-308-4108
Mailing Address - Street 1:5401 THELEN AVE
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7641
Mailing Address - Country:US
Mailing Address - Phone:847-323-1199
Mailing Address - Fax:
Practice Address - Street 1:1020 W ROLLINS RD
Practice Address - Street 2:
Practice Address - City:ROULD LAKE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60073
Practice Address - Country:US
Practice Address - Phone:224-308-4108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAMARI COUNSELING AND MENTORING COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007662101YP2500X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty