Healthcare Provider Details

I. General information

NPI: 1154552420
Provider Name (Legal Business Name): MICHELLE SHALIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 BIRCH RD
NORTHBROOK IL
60062-5907
US

IV. Provider business mailing address

1733 BIRCH RD
NORTHBROOK IL
60062-5907
US

V. Phone/Fax

Practice location:
  • Phone: 847-877-3540
  • Fax:
Mailing address:
  • Phone: 847-877-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008038
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178006166
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number2348999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: