Provider Demographics
NPI:1033520457
Name:LURK, JODY K (LCPC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:K
Last Name:LURK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 EAST MARKET STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:RED BUD
Mailing Address - State:IL
Mailing Address - Zip Code:62278
Mailing Address - Country:US
Mailing Address - Phone:618-340-9578
Mailing Address - Fax:800-707-1357
Practice Address - Street 1:215 EAST MARKET STREET
Practice Address - Street 2:SUITE B
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278
Practice Address - Country:US
Practice Address - Phone:618-340-9578
Practice Address - Fax:800-707-1357
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional