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General NPI Number Information
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NPI Number | 1881969699
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Entity Type | Individual
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Provider Name | MR. LEONIDAS NICKOLAOS LOUKAS
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Gender | Male
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Dates
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Enumeration Date | 03/12/2012
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 4723 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-1722
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Country | US
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Telephone | 847-373-0047
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Fax | 888-400-0610
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Provider Business Mailing Address
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Address Line | 4723 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-1722
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Country | US
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Telephone | 847-373-0047
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Fax | 888-400-0610
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180.007923
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License Number State | IL
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