Basic Information
| Provider Information | |||||||||
| NPI: | 1700101870 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHELLEY SKAS MA LCPC SC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HEALING CENTER AT SILVER LAKE GARDENS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15127 S 73RD AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085869303 | ||||||||
| FaxNumber: | 8869509427 | ||||||||
| Practice Location | |||||||||
| Address1: | 15127 S 73RD AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085869303 | ||||||||
| FaxNumber: | 8669509427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2010 | ||||||||
| LastUpdateDate: | 04/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | SKAS | ||||||||
| AuthorizedOfficialFirstName: | SHELLEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED CLINCIAL PROFESSIONAL COUN | ||||||||
| AuthorizedOfficialTelephone: | 7085869303 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCPC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180007474 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.