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General NPI Number Information
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NPI Number | 1619480019
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Entity Type | Organization
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Legal Business Name | SHIFT COUNSELING, P.C.
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 9007 W CERMAK RD
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1017
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Country | US
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Telephone | 708-522-4009
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Fax | 630-233-9332
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Provider Business Mailing Address
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Address Line | 9007 W CERMAK RD
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1017
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Country | US
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Telephone | 708-522-4009
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Fax | 630-233-9332
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA MALLEY FITZGERALD
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Credential | LCPC
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Telephone | 708-522-4009
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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 | 180007277
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License Number State | IL
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