Provider Demographics
NPI:1538234471
Name:SHENK, COREY M (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:M
Last Name:SHENK
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E WINCHESTER RD
Mailing Address - Street 2:UNIT F
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1356
Mailing Address - Country:US
Mailing Address - Phone:847-997-8667
Mailing Address - Fax:
Practice Address - Street 1:113 E WINCHESTER RD
Practice Address - Street 2:UNIT F
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1356
Practice Address - Country:US
Practice Address - Phone:847-997-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional