Provider Demographics
NPI:1821275249
Name:SHIZAS, NICKOLAS G (LCPC)
Entity Type:Individual
Prefix:
First Name:NICKOLAS
Middle Name:G
Last Name:SHIZAS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13820 S 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1645
Mailing Address - Country:US
Mailing Address - Phone:708-308-0004
Mailing Address - Fax:
Practice Address - Street 1:13820 S 88TH AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1645
Practice Address - Country:US
Practice Address - Phone:708-308-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional