Provider Demographics
NPI:1194521229
Name:SHAW, ALYSSA (LPC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SHAW
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 W BELMONT AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9479
Mailing Address - Country:US
Mailing Address - Phone:312-508-3645
Mailing Address - Fax:
Practice Address - Street 1:132 W JEFFERSON AVE STE 208
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5007
Practice Address - Country:US
Practice Address - Phone:331-267-7927
Practice Address - Fax:312-971-8554
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional