Provider Demographics
NPI:1154093268
Name:LARUE, JUDITH BARNES (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:BARNES
Last Name:LARUE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 W WAVELAND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3527
Mailing Address - Country:US
Mailing Address - Phone:773-549-5261
Mailing Address - Fax:
Practice Address - Street 1:4801 W PETERSON AVE STE 308
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5726
Practice Address - Country:US
Practice Address - Phone:773-808-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180004685OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR