Healthcare Provider Details

I. General information

NPI: 1265104285
Provider Name (Legal Business Name): TAYLOR BETH LUND LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 159TH ST STE C
OAK FOREST IL
60452-2904
US

IV. Provider business mailing address

8247 45TH ST
LYONS IL
60534-1704
US

V. Phone/Fax

Practice location:
  • Phone: 708-535-7320
  • Fax:
Mailing address:
  • Phone: 815-718-2437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.017232
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: