Provider Demographics
NPI:1619480019
Name:SHIFT COUNSELING, P.C.
Entity Type:Organization
Organization Name:SHIFT COUNSELING, P.C.
Other - Org Name:REBECCA MALLEY LCPC, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MALLEY
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-522-4009
Mailing Address - Street 1:9007 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1017
Mailing Address - Country:US
Mailing Address - Phone:708-522-4009
Mailing Address - Fax:630-233-9332
Practice Address - Street 1:9007 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1017
Practice Address - Country:US
Practice Address - Phone:708-522-4009
Practice Address - Fax:630-233-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty