Provider Demographics
NPI:1831687839
Name:SHORTER, TOMIKA L (LPC)
Entity type:Individual
Prefix:
First Name:TOMIKA
Middle Name:L
Last Name:SHORTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1032
Mailing Address - Country:US
Mailing Address - Phone:630-717-2258
Mailing Address - Fax:
Practice Address - Street 1:600 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232-1329
Practice Address - Country:US
Practice Address - Phone:618-234-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)