Provider Demographics
NPI:1740813021
Name:LACKEY, SHAIREE (LCPC, LPC, NCC)
Entity type:Individual
Prefix:
First Name:SHAIREE
Middle Name:
Last Name:LACKEY
Suffix:
Gender:F
Credentials:LCPC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6072
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-6072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1603 ORRINGTON AVE STE 600
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3860
Practice Address - Country:US
Practice Address - Phone:312-585-7409
Practice Address - Fax:312-525-9733
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health