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General NPI Number Information
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NPI Number | 1548649106
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Entity Type | Organization
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Legal Business Name | LOCUS THERAPY CENTER LLC
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 25 E WASHINGTON ST SUITE 1210
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-659-6591
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Fax | 312-980-0837
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Provider Business Mailing Address
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Address Line | 25 E WASHINGTON ST SUITE 1210
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City | CHICAGO
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State | IL
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Zip | 60602-1708
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Country | US
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Telephone | 312-659-6591
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Fax | 312-980-0837
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Authorized Official
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Title or Position | OWNER
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Name | ANNA LAMDEN
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Credential | LPC
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Telephone | 312-659-6591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178009168
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License Number State | IL
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