Healthcare Provider Details

I. General information

NPI: 1487527461
Provider Name (Legal Business Name): SHELBY NOEL GRAVES LPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 RENAISSANCE DR STE 320
PARK RIDGE IL
60068-1471
US

IV. Provider business mailing address

4827 N WOLCOTT AVE APT 3A
CHICAGO IL
60640-4035
US

V. Phone/Fax

Practice location:
  • Phone: 847-759-9110
  • Fax:
Mailing address:
  • Phone: 503-707-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number22382
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178019153
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: