Provider Demographics
NPI:1750703708
Name:SHAH, CHANDRAKANT KANTILAL (PHD LCPC)
Entity type:Individual
Prefix:MR
First Name:CHANDRAKANT
Middle Name:KANTILAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHD LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9418 DEE RD
Mailing Address - Street 2:UNITE NO.2E
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3866
Mailing Address - Country:US
Mailing Address - Phone:224-409-4037
Mailing Address - Fax:
Practice Address - Street 1:9418 DEE RD
Practice Address - Street 2:UNITE NO.2E
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-3866
Practice Address - Country:US
Practice Address - Phone:224-409-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002818103TB0200X, 103TC2200X, 103TP2701X
IL180.002818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy