Healthcare Provider Details

I. General information

NPI: 1447041314
Provider Name (Legal Business Name): LISA ROBIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10343 S HOMAN AVE
CHICAGO IL
60655-2422
US

IV. Provider business mailing address

10343 S HOMAN AVE
CHICAGO IL
60655-2422
US

V. Phone/Fax

Practice location:
  • Phone: 708-307-3654
  • Fax:
Mailing address:
  • Phone: 708-307-3654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.008349
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number178.008349
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: