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NPI Code Detail

MEDICARE: SHANNON B MCCRAY LCPC

MEDICARE: SHANNON B MCCRAY LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor31986IL
2101YP2500XProfessional Counselor180013871IL
3101YP2500XProfessional Counselor178.009904IL

General Provider Information

NPI Number : 1104365196
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON B MCCRAY LCPC
Provider Business Mailing Address
First Line : 2744 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-2343
Country : US
Telephone Number : 773-434-4626
Fax Number :
Provider Business Practice Location Address
First Line : 2744 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-2343
Country : US
Telephone Number : 773-434-4626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2017
Last Update Date : 11/08/2023

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Directions to “ SHANNON B MCCRAY LCPC” Practice Location

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