Provider Demographics
NPI:1235464025
Name:IRVIN, LAURA S (LCPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:IRVIN
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 1:702 REDWING DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3142
Mailing Address - Country:US
Mailing Address - Phone:630-303-3144
Mailing Address - Fax:
Practice Address - Street 1:702 REDWING DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3142
Practice Address - Country:US
Practice Address - Phone:630-303-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.003945OtherST OF IL DEPT OF FINANCIAL AND PROFESSIONAL REGULATION - DIV OF PROFESSIONAL REG