Provider Demographics
NPI:1083173520
Name:LACKAYE THERAPY AND ADVOCACY LLC
Entity Type:Organization
Organization Name:LACKAYE THERAPY AND ADVOCACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKAYE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-356-7909
Mailing Address - Street 1:2736 N SOUTHPORT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1230
Mailing Address - Country:US
Mailing Address - Phone:573-356-7909
Mailing Address - Fax:
Practice Address - Street 1:2736 N SOUTHPORT AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1230
Practice Address - Country:US
Practice Address - Phone:573-356-7909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty