Organization
EAR TO EAR BEHAVIORAL HEALTH SOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COREY WENDELL SHUMATE PMHNP-BC (NURSE PRACTITIONER)
(708) 208-4651
Entity
Organization
Contact information
Practice address
201 W LAKE ST, CHICAGO, IL 60606-0239
(773) 232-2222
(773) 232-1893
Mailing address
924 N AUSTIN BLVD, OAK PARK, IL 60302-1713
(708) 208-4651
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
07/05/2021
Last updated
11/22/2021
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