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General NPI Number Information
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NPI Number | 1740813021
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Entity Type | Individual
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Provider Name | SHAIREE LACKEY PHD, LCPC, CADC
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Gender | Female
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Dates
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Enumeration Date | 02/15/2020
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 1603 ORRINGTON AVE STE 600
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City | EVANSTON
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State | IL
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Zip | 60201-3860
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Country | US
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Telephone | 312-585-7409
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Fax | 312-525-9733
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Provider Business Mailing Address
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Address Line | PO BOX 6072
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City | EVANSTON
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State | IL
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Zip | 60204-6072
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Country | US
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Telephone |
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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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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 |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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Taxonomy #3
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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