Provider Demographics
NPI:1265142095
Name:WANG, SHUYU (LMFT)
Entity type:Individual
Prefix:
First Name:SHUYU
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHUYU
Other - Middle Name:
Other - Last Name:YUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:771 BROADVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4617
Mailing Address - Country:US
Mailing Address - Phone:312-989-5432
Mailing Address - Fax:
Practice Address - Street 1:771 BROADVIEW AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4617
Practice Address - Country:US
Practice Address - Phone:312-989-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000695106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist