=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497272769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKEFRONT COUNSELING GROUP, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2017
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 N MICHIGAN AVE STE 609
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60601-7506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-942-2006
-----------------------------------------------------
Fax | 312-239-6000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 N MICHIGAN AVE STE 609
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60601-7511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-942-2006
-----------------------------------------------------
Fax | 312-239-6000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST, OWNER
-----------------------------------------------------
Name | DR. ROBYNE FRANKFORT HOWARD
-----------------------------------------------------
Credential | PSY.D
-----------------------------------------------------
Telephone | 847-942-2006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 071006138
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------