MEDICARE: LUJUANA ALLEN-LIGHTFOOT LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178.014010	IL

General Provider Information

NPI Number	:	1609528074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUJUANA ALLEN-LIGHTFOOT LPC

Provider Business Mailing Address
First Line	:	11303 S LANGLEY AVE UNIT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-5125
Country	:	US
Telephone Number	:	313-929-1345
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 W NORTH AVE STE 2A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5413
Country	:	US
Telephone Number	:	773-340-0203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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