Healthcare Provider Details

I. General information

NPI: 1699601252
Provider Name (Legal Business Name): COLLIN MCSHANE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W GOLF RD STE 30
ARLINGTON HEIGHTS IL
60005-3923
US

IV. Provider business mailing address

2556 PRAIRIE AVE APT 16
EVANSTON IL
60201-5804
US

V. Phone/Fax

Practice location:
  • Phone: 847-282-0491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.014049
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: