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General NPI Number Information
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NPI Number | 1811379084
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Entity Type | Individual
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Provider Name | SHAWN CLIFFORD GARRY
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Gender | Male
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | 2570 FOXFIELD RD STE 107
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City | ST CHARLES
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State | IL
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Zip | 60174-1406
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Country | US
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Telephone | 815-344-1230
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Fax | 847-859-5885
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Provider Business Mailing Address
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Address Line | 175 E HAWTHORN PKWY STE 235
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City | VERNON HILLS
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State | IL
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Zip | 60061-1454
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Country | US
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Telephone | 847-868-3435
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Fax | 847-859-5885
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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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 | 180013552
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.014489
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License Number State | IL
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