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NPI Code Detail

MEDICARE: SHAIREE LACKEY PHD, LCPC, CADC

MEDICARE: SHAIREE LACKEY PHD, LCPC, CADC
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
1101YM0800XMental Health Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor
3103TH0004XHealth Psychologist
4390200000XStudent in an Organized Health Care Education/Training Program
5101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1740813021
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAIREE LACKEY PHD, LCPC, CADC
Provider Business Mailing Address
First Line : PO BOX 6072
Second Line :
City : EVANSTON
State : IL
Zip : 60204-6072
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1603 ORRINGTON AVE STE 600
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3860
Country : US
Telephone Number : 312-585-7409
Fax Number : 312-525-9733
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2020
Last Update Date : 01/19/2026

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