Provider Demographics
NPI:1740163591
Name:GARZA-SHALAVEYUS, ELSA MARINA (LCPC)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:MARINA
Last Name:GARZA-SHALAVEYUS
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 1:1259 W WINONA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2907
Mailing Address - Country:US
Mailing Address - Phone:773-507-5508
Mailing Address - Fax:
Practice Address - Street 1:1259 W WINONA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2907
Practice Address - Country:US
Practice Address - Phone:773-507-5508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-016288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional