Provider Demographics
NPI:1093921652
Name:LALL, KRISHNA BEHARI (KRISHNA LALL,PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:BEHARI
Last Name:LALL
Suffix:
Gender:M
Credentials:KRISHNA LALL,PSYD
Other - Prefix:DR
Other - First Name:KRISHNA
Other - Middle Name:BEHARI
Other - Last Name:LALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:17 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2321
Mailing Address - Country:US
Mailing Address - Phone:630-368-1553
Mailing Address - Fax:630-368-1545
Practice Address - Street 1:17 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2321
Practice Address - Country:US
Practice Address - Phone:630-368-1553
Practice Address - Fax:630-368-1545
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist