Healthcare Provider Details

I. General information

NPI: 1558980714
Provider Name (Legal Business Name): KRINA A SHAH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRINA ADHIKARI

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 W TAYLOR ST # 1942
CHICAGO IL
60607-4623
US

IV. Provider business mailing address

1440 W TAYLOR ST # 1942
CHICAGO IL
60607-4623
US

V. Phone/Fax

Practice location:
  • Phone: 203-312-7676
  • Fax:
Mailing address:
  • Phone: 203-312-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4148
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC-0011221
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number017455
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00829600
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016952
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-2183
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: