Provider Demographics
NPI:1710606819
Name:SPENCER, SHEMARI ASHANTI (LMFT)
Entity type:Individual
Prefix:
First Name:SHEMARI
Middle Name:ASHANTI
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 W 80TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-2419
Mailing Address - Country:US
Mailing Address - Phone:773-480-9469
Mailing Address - Fax:
Practice Address - Street 1:2302 W NORTH AVE STE 1E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-9755
Practice Address - Country:US
Practice Address - Phone:312-210-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001818106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist