Provider Demographics
NPI:1053004804
Name:SHEA, CAITLIN MARIE (LPC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARIE
Last Name:SHEA
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 1:3018 W CULLERTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-2257
Mailing Address - Country:US
Mailing Address - Phone:440-520-3370
Mailing Address - Fax:
Practice Address - Street 1:3018 W CULLERTON ST APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-2257
Practice Address - Country:US
Practice Address - Phone:440-520-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health