Healthcare Provider Details

I. General information

NPI: 1467975417
Provider Name (Legal Business Name): INNER OUTLOOK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 SOUTH BLVD
EVANSTON IL
60202-2767
US

IV. Provider business mailing address

848 DODGE AVE # 256
EVANSTON IL
60202-1506
US

V. Phone/Fax

Practice location:
  • Phone: 773-480-3273
  • Fax: 773-326-2444
Mailing address:
  • Phone: 773-480-3273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180005774
License Number StateIL

VIII. Authorized Official

Name: SHABAD KAUR KHALSA
Title or Position: PRINCIPAL OWNER
Credential: LCPC, LMFT
Phone: 773-480-3273