Provider Demographics
NPI:1992276703
Name:MEHTA, SHANE SABNANI (LCPC)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:SABNANI
Last Name:MEHTA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 N MICHIGAN AVE STE 2130
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6747
Mailing Address - Country:US
Mailing Address - Phone:773-789-9775
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE STE 2130
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6747
Practice Address - Country:US
Practice Address - Phone:773-789-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional