Healthcare Provider Details

I. General information

NPI: 1144948670
Provider Name (Legal Business Name): LAURA SOFIA MURPHY GARCIA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MAIN ST
MELROSE PARK IL
60160-3902
US

IV. Provider business mailing address

777 CENTRAL AVE SUITE 17
HIGHLAND PARK IL
60035
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-0073
  • Fax:
Mailing address:
  • Phone: 847-432-4981
  • Fax: 847-432-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.014441
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: