SHELLEY M FORMAN Professional Counselor License verification

Business Entity

NOT RENEWED

License Type

Professional Counselor

Description

LICENSED CLINICAL PROFESSIONAL COUNSELOR

License Number

180001362

License Status

NOT RENEWED

Business

First Name

SHELLEY

Middle

Last Name

FORMAN

Business Name

SHELLEY M FORMAN

Original Issue Date

06/12/1996

Effective Date

02/18/2015

Expiration Date

03/31/2017

City

NORTHBROOK

State

Zip

60062

County

COOK

Ever Disciplined

LastModifiedDate

05/10/2017