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General NPI Number Information
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NPI Number | 1043795677
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Entity Type | Individual
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Provider Name | POOJA RAJESH SHAH
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Gender | Female
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 205 N MICHIGAN AVE STE 810
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City | CHICAGO
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State | IL
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Zip | 60601-5902
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Country | US
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Telephone | 414-810-6820
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N JEFFERSON ST APT 604
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City | CHICAGO
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State | IL
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Zip | 60661-1199
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Country | US
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Telephone | 214-476-9690
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | AMFT118089
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166001568
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License Number State | IL
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