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NPI Code Detail

MEDICARE: ROBERT DEAN LELAURIN JR.

MEDICARE: ROBERT DEAN LELAURIN JR.
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
1101YM0800XMental Health Counselor
2101YM0800XMental Health Counselor178.018015IL

General Provider Information

NPI Number : 1619644721
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT DEAN LELAURIN JR.
Provider Business Mailing Address
First Line : 53 W JACKSON BLVD STE 510
Second Line :
City : CHICAGO
State : IL
Zip : 60604-3434
Country : US
Telephone Number : 312-834-7221
Fax Number :
Provider Business Practice Location Address
First Line : 53 W JACKSON BLVD STE 1615
Second Line :
City : CHICAGO
State : IL
Zip : 60604-3722
Country : US
Telephone Number : 312-834-7221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2021
Last Update Date : 04/30/2022

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