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General NPI Number Information
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NPI Number | 1003552399
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Entity Type | Organization
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Legal Business Name | LESLIE LUND PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 1916 ROWELL AVE
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City | JOLIET
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State | IL
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Zip | 60433-8548
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Country | US
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Telephone | 815-531-2049
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Fax |
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Provider Business Mailing Address
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Address Line | 915 W MARGATE TER APT G
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City | CHICAGO
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State | IL
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Zip | 60640-3083
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Country | US
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Telephone | 815-531-2049
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LESLIE LUND
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Credential | LCPC
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Telephone | 815-531-2049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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