Provider Demographics
NPI:1952780264
Name:SHEADE PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:SHEADE PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHEADE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-999-9987
Mailing Address - Street 1:4411 N RAVENSWOOD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5802
Mailing Address - Country:US
Mailing Address - Phone:773-999-9987
Mailing Address - Fax:847-780-3360
Practice Address - Street 1:4411 N RAVENSWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5802
Practice Address - Country:US
Practice Address - Phone:773-999-9987
Practice Address - Fax:847-868-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009684101YP2500X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty