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General NPI Number Information
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NPI Number | 1841080744
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Entity Type | Organization
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Legal Business Name | AJL PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 4611 N RAVENSWOOD AVE STE 205
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City | CHICAGO
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State | IL
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Zip | 60640-7577
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Country | US
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Telephone | 708-296-4468
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Fax |
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Provider Business Mailing Address
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Address Line | 4511 N DOVER ST APT 1S
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City | CHICAGO
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State | IL
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Zip | 60640-6295
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Country | US
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Telephone | 708-296-4468
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Fax |
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Authorized Official
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Title or Position | OWNER / PSYCHOTHERAPIST
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Name | ALEXANDRA JEANNE LUTZ
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Credential | MA, LCPC
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Telephone | 708-296-4468
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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 |
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License Number State |
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