Individual provider Active NPI

Shelby Grace Cusack

  • Counselor
  • Chicago, IL
National Provider Identifier
1487384392
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Practice address
311 W Superior St Ste 402
Chicago, IL 60654-3537
Phone
(312) 584-2144
Fax
(312) 971-8554
NPI assigned
Jun 14, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X Primary

Addresses

Primary practice location

311 W Superior St Ste 402
Chicago, IL 60654-3537

Mailing address

1438 W Belmont Ave Ste 1
Chicago, IL 60657-2166
Phone (312) 508-3645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Light on Anxiety, P.C. Counselor CurrentSince Jun 1, 2022 Accepting new patients

Locations

311 W Superior St
Ste 402
Chicago, IL 60654
Phone (312) 584-2144

1438 W Belmont Ave
Ste 1
Chicago, IL 60657
Phone 3125083645 ext. 36

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1487384392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1438 W BELMONT AVE STE 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572166",
            "telephone_number": "312-508-3645",
            "fax_number": "312-971-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W SUPERIOR ST STE 402",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606543537",
            "telephone_number": "312-584-2144",
            "fax_number": "312-971-8554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSACK",
        "first_name": "SHELBY",
        "middle_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-14",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.