Provider Demographics
NPI:1326334467
Name:LOU, JANE A (LCPC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:LOU
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 1:1128 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3612
Mailing Address - Country:US
Mailing Address - Phone:847-668-3432
Mailing Address - Fax:847-281-7247
Practice Address - Street 1:415 E GOLF RD STE 115
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-668-3432
Practice Address - Fax:847-281-7247
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health