Provider Demographics
NPI:1326790973
Name:SHAHA, ANAMIKA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ANAMIKA
Middle Name:
Last Name:SHAHA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:SHAHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:155 N MICHIGAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7940
Mailing Address - Country:US
Mailing Address - Phone:738-131-2819
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7940
Practice Address - Country:US
Practice Address - Phone:738-131-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178.017122OtherPROFESSIONAL LICENSE NUMBER