Healthcare Provider Details

I. General information

NPI: 1003940701
Provider Name (Legal Business Name): LOIS GOUDEAU M.ED. MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 HOHMAN AVE
HAMMOND IN
46320-1742
US

IV. Provider business mailing address

3402 173RD ST
LANSING IL
60438-1306
US

V. Phone/Fax

Practice location:
  • Phone: 708-270-3147
  • Fax:
Mailing address:
  • Phone: 708-743-7347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.012096
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.012096
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: