SHELLEY M FORMAN - Professional Counselor License in Illinois | # 180001362

SHELLEY M FORMAN

Business Entity

NOT RENEWED

License Type

Professional Counselor

Description

LICENSED CLINICAL PROFESSIONAL COUNSELOR

License Number

180001362

License Status

NOT RENEWED

Business

N

First Name

SHELLEY

Middle

M

Last Name

FORMAN

Business Name

SHELLEY M FORMAN

Original Issue Date

06/12/1996

Effective Date

02/18/2015

Expiration Date

03/31/2017

State

IL

Ever Disciplined

N

LastModifiedDate

05/10/2017