Healthcare Provider Details

I. General information

NPI: 1851708994
Provider Name (Legal Business Name): SAIRA KHAN LCPC, CADC, CTTS,NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 CAMPBELL DR
GURNEE IL
60031-3112
US

IV. Provider business mailing address

915 CAMPBELL DR
GURNEE IL
60031-3112
US

V. Phone/Fax

Practice location:
  • Phone: 224-440-2665
  • Fax:
Mailing address:
  • Phone: 224-440-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC10035
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180012189
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: