Provider Demographics
NPI:1487790945
Name:HAURY, SHEA (LCPC)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:HAURY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:SHEA
Other - Middle Name:
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1116 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-1053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10257 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-4418
Practice Address - Country:US
Practice Address - Phone:618-282-6233
Practice Address - Fax:618-282-6220
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional