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General NPI Number Information
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NPI Number | 1487527461
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Entity Type | Individual
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Provider Name | SHELBY NOEL GRAVES LPC, ATR
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Gender | Female
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 1440 RENAISSANCE DR STE 320
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City | PARK RIDGE
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State | IL
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Zip | 60068-1471
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Country | US
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Telephone | 847-759-9110
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Fax |
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Provider Business Mailing Address
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Address Line | 4827 N WOLCOTT AVE APT 3A
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City | CHICAGO
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State | IL
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Zip | 60640-4035
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Country | US
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Telephone | 503-707-1341
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 22382
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178019153
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License Number State | IL
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