Provider Demographics
NPI:1295312809
Name:SMITH, SHELBY DIONNE (LMFT)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:DIONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 HUNTINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-4419
Mailing Address - Country:US
Mailing Address - Phone:630-229-2070
Mailing Address - Fax:
Practice Address - Street 1:2220 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-4419
Practice Address - Country:US
Practice Address - Phone:630-229-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-28
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166001454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty