Organization
INSIDEOUT LIVING INC II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA LACKEY M.A.,LCPC,CSAT,CMAT (CHIEF ENGAGEMENT OFFICER)
(847) 328-7588
Entity
Organization
Contact information
Practice address
1618 ORRINGTON AVE STE 311, EVANSTON, IL 60201-5016
(847) 868-6783
Mailing address
1618 ORRINGTON AVE STE 311, EVANSTON, IL 60201-5016
(847) 868-6783
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
180-007-044
IL
Other
Enumeration date
05/14/2018
Last updated
05/14/2018
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