Provider Demographics
NPI:1639494487
Name:SKAS, SHELLEY (LCPC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:SKAS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:HEALING CENTER AT
Other - Middle Name:SILVER LAKE
Other - Last Name:GARDENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:15127 S 73RD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4398
Mailing Address - Country:US
Mailing Address - Phone:708-586-9303
Mailing Address - Fax:866-950-9427
Practice Address - Street 1:15127 S 73RD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4398
Practice Address - Country:US
Practice Address - Phone:708-586-9303
Practice Address - Fax:866-950-9427
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional