Provider Demographics
NPI:1467967760
Name:KANIKA SHUKUL, LCPC, LLC
Entity Type:Organization
Organization Name:KANIKA SHUKUL, LCPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:KANIKA
Authorized Official - Middle Name:NAVNEET
Authorized Official - Last Name:SHUKUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-832-7878
Mailing Address - Street 1:4707 N BROADWAY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4999
Mailing Address - Country:US
Mailing Address - Phone:773-832-7878
Mailing Address - Fax:773-832-7878
Practice Address - Street 1:4707 N BROADWAY ST STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4999
Practice Address - Country:US
Practice Address - Phone:773-832-7878
Practice Address - Fax:773-832-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009713261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)