Provider Demographics
NPI:1275125684
Name:DEMONTE, LUCAS C (MED, EDS, LPC)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:C
Last Name:DEMONTE
Suffix:
Gender:M
Credentials:MED, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 NORMAL RD APT 109
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2260
Mailing Address - Country:US
Mailing Address - Phone:352-727-2516
Mailing Address - Fax:
Practice Address - Street 1:682 W BOUGHTON RD STE B
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2199
Practice Address - Country:US
Practice Address - Phone:352-727-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016709101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty