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Organization
LISA WALLACE
Active
Organization
LISA WALLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA WALLACE LCPC (PROVIDER)
(708) 906-0205
Entity
Organization
Contact information
Practice address
20200 GOVERNORS DR, 107, OLYMPIA FIELDS, IL 60461-1032
(708) 462-4235
Mailing address
1835 W 34TH ST, STEGER, IL 60475-1499
(708) 906-0205
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
180.008731
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
180.008731
IL
101YM0800X
Mental Health Counselor
Primary
180.008731
IL
101YP1600X
Pastoral Counselor
180.008731
IL
101YP2500X
Professional Counselor
180.008731
IL
106H00000X
Marriage & Family Therapist
180.008731
IL
Other
Enumeration date
06/27/2014
Last updated
06/27/2014
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