Provider Demographics
NPI:1275720203
Name:LAMMERT, MICHAEL (LCPC/CRADC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LAMMERT
Suffix:
Gender:M
Credentials:LCPC/CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX M
Mailing Address - Street 2:504 MICAH DRIVE
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-0913
Mailing Address - Country:US
Mailing Address - Phone:618-395-4306
Mailing Address - Fax:618-395-4507
Practice Address - Street 1:1501 OLIVE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2269
Practice Address - Country:US
Practice Address - Phone:618-943-3451
Practice Address - Fax:618-943-4368
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1875OtherCRADC