MEDICARE: NICHOLAS MICHAEL SHILNEY 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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	180.017026	IL

General Provider Information

NPI Number	:	1558914317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MICHAEL SHILNEY LCPC

Provider Business Mailing Address
First Line	:	12 SCARSDALE RD
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-2518
Country	:	US
Telephone Number	:	630-715-8224
Fax Number	:

Provider Business Practice Location Address
First Line	:	331 W SURF ST STE 809
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-7227
Country	:	US
Telephone Number	:	312-761-4721
Fax Number	:

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

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	03/11/2026

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