Provider Demographics
NPI:1396844833
Name:CARNAHAN, LORI E
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:E
Last Name:CARNAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N LOMBARD AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2011
Mailing Address - Country:US
Mailing Address - Phone:630-376-6148
Mailing Address - Fax:
Practice Address - Street 1:120 S MARION 4TH FL
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302
Practice Address - Country:US
Practice Address - Phone:708-406-3112
Practice Address - Fax:708-383-1253
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health