Provider Demographics
NPI:1568926855
Name:VYAS, SHOMA (LCPC)
Entity Type:Individual
Prefix:
First Name:SHOMA
Middle Name:
Last Name:VYAS
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 1:645 N KINGSBURY ST APT 2502
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6868
Mailing Address - Country:US
Mailing Address - Phone:516-286-8350
Mailing Address - Fax:
Practice Address - Street 1:645 N KINGSBURY ST APT 2502
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-6868
Practice Address - Country:US
Practice Address - Phone:516-286-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional