Healthcare Provider Details

I. General information

NPI: 1902460645
Provider Name (Legal Business Name): KATRINA LOBUE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 424
CHICAGO IL
60602-3844
US

IV. Provider business mailing address

30 N MICHIGAN AVE STE 424
CHICAGO IL
60602-3844
US

V. Phone/Fax

Practice location:
  • Phone: 312-279-9981
  • Fax: 312-279-9981
Mailing address:
  • Phone: 312-279-9981
  • Fax: 312-279-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178014854
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number180013504
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: