Provider Demographics
NPI:1093129710
Name:MCSHANE, KATHLEEN MARGUERITE (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARGUERITE
Last Name:MCSHANE
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Gender:F
Credentials:MA, LCPC
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Mailing Address - Street 1:10540 S WESTERN AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2536
Mailing Address - Country:US
Mailing Address - Phone:312-315-5210
Mailing Address - Fax:773-614-8078
Practice Address - Street 1:10540 S WESTERN AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2536
Practice Address - Country:US
Practice Address - Phone:312-315-5210
Practice Address - Fax:773-614-8078
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL180.009576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional