Provider Demographics
NPI:1982367165
Name:SHINE, JOSETTE (LCPC)
Entity type:Individual
Prefix:
First Name:JOSETTE
Middle Name:
Last Name:SHINE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 W LAKE ST STE 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1034
Mailing Address - Country:US
Mailing Address - Phone:708-926-4645
Mailing Address - Fax:
Practice Address - Street 1:661 W LAKE ST STE 2S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1034
Practice Address - Country:US
Practice Address - Phone:708-926-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013866101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health