Healthcare Provider Details

I. General information

NPI: 1154365831
Provider Name (Legal Business Name): SHABAD KAUR KHALSA LCPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 DODGE AVE # 256
EVANSTON IL
60202-1506
US

IV. Provider business mailing address

4255 N HONORE ST STE 219
CHICAGO IL
60613-4572
US

V. Phone/Fax

Practice location:
  • Phone: 773-480-3273
  • Fax: 773-326-2444
Mailing address:
  • Phone: 773-975-9754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166000327
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180005774
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: