Provider Demographics
NPI:1144508961
Name:TARNOWSKI, LAWRENCE WILLIAM III (MA, LCPC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:TARNOWSKI
Suffix:III
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15347 S 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4117
Mailing Address - Country:US
Mailing Address - Phone:708-217-1896
Mailing Address - Fax:
Practice Address - Street 1:21016 S 80TH AVE
Practice Address - Street 2:SUITE #8
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9203
Practice Address - Country:US
Practice Address - Phone:815-464-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional