Provider Demographics
NPI:1477881142
Name:LAI, JINGLAM (AMFT, MS)
Entity Type:Individual
Prefix:
First Name:JINGLAM
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:AMFT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3863
Mailing Address - Country:US
Mailing Address - Phone:815-282-6153
Mailing Address - Fax:815-282-7160
Practice Address - Street 1:6701 CLINTON RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3863
Practice Address - Country:US
Practice Address - Phone:815-282-6153
Practice Address - Fax:815-282-7160
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist