Provider Demographics
NPI:1457067506
Name:FORCUM, SHIRLEY MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:MARIE
Last Name:FORCUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:TILDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62292-0604
Mailing Address - Country:US
Mailing Address - Phone:618-317-1517
Mailing Address - Fax:
Practice Address - Street 1:10257 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-4418
Practice Address - Country:US
Practice Address - Phone:618-282-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0201981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical