Healthcare Provider Details

I. General information

NPI: 1245259985
Provider Name (Legal Business Name): LORI L LUBBS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W SOUTH ST
KEWANEE IL
61443-8354
US

IV. Provider business mailing address

1051 W SOUTH ST
KEWANEE IL
61443-8354
US

V. Phone/Fax

Practice location:
  • Phone: 309-852-7700
  • Fax: 309-852-7764
Mailing address:
  • Phone: 309-852-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-002053
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: