Provider Demographics
NPI:1356860282
Name:TILLETT, LUCAS M (LPC)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:M
Last Name:TILLETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7767 MILAN WAY
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5177
Mailing Address - Country:US
Mailing Address - Phone:1847-946-3428
Mailing Address - Fax:
Practice Address - Street 1:1580 S MILWAUKEE AVE STE 307
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3773
Practice Address - Country:US
Practice Address - Phone:847-946-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health