MEDICARE: SHIRA R GREENFIELD LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180004326	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05619771	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1356340665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRA R GREENFIELD LCPC

Provider Business Mailing Address
First Line	:	610 CRYSTAL POINT DR
Second Line	:	SUITE 3
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-1401
Country	:	US
Telephone Number	:	815-735-6863
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 CRYSTAL POINT DR
Second Line	:	SUITE 3
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-1401
Country	:	US
Telephone Number	:	815-735-6863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	05/08/2017

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