Healthcare Provider Details

I. General information

NPI: 1760698849
Provider Name (Legal Business Name): MICHAEL LALIC LCSW, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 86TH AVE SUITE 119S
MERRILLVILLE IN
46410-7063
US

IV. Provider business mailing address

1614 W 99TH PL
CROWN POINT IN
46307-5402
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-8944
  • Fax: 219-756-8945
Mailing address:
  • Phone: 219-663-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002925A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000047A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: