Provider Demographics
NPI:1699215632
Name:PATEL, SHRUTI (LCPC)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:PATEL
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 1:4127 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7544
Mailing Address - Country:US
Mailing Address - Phone:847-971-0015
Mailing Address - Fax:
Practice Address - Street 1:1167 WILMETTE AVE STE 206
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2643
Practice Address - Country:US
Practice Address - Phone:312-687-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional