Provider Demographics
NPI:1801553607
Name:SHALASH, JANINE-SARA (CMHC INTERN)
Entity type:Individual
Prefix:
First Name:JANINE-SARA
Middle Name:
Last Name:SHALASH
Suffix:
Gender:F
Credentials:CMHC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9641 W 153RD ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3775
Mailing Address - Country:US
Mailing Address - Phone:708-875-1349
Mailing Address - Fax:
Practice Address - Street 1:9641 W 153RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3775
Practice Address - Country:US
Practice Address - Phone:708-875-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health