Provider Demographics
NPI:1356475842
Name:LABELLE, DOUGLAS S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:S
Last Name:LABELLE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 ROCKLAND RD
Mailing Address - Street 2:STE. 103
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1782
Mailing Address - Country:US
Mailing Address - Phone:847-309-3781
Mailing Address - Fax:847-482-1688
Practice Address - Street 1:655 ROCKLAND RD
Practice Address - Street 2:STE. 103
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1782
Practice Address - Country:US
Practice Address - Phone:847-309-3781
Practice Address - Fax:847-482-1688
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68911231041C0700X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical