Healthcare Provider Details

I. General information

NPI: 1861973430
Provider Name (Legal Business Name): GARTH WILLIAM LAHUE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 809
CHICAGO IL
60602-3776
US

IV. Provider business mailing address

5866 N MEDINA AVE
CHICAGO IL
60646-5304
US

V. Phone/Fax

Practice location:
  • Phone: 312-767-2057
  • Fax:
Mailing address:
  • Phone: 262-822-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: