=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356816581
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA VAN DYKE LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2018
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1717 N NAPER BLVD STE 109
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-8837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-868-3435
-----------------------------------------------------
Fax | 847-859-5885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 E DIEHL RD STE 101
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60563-2394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-328-0134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180017204
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------