Provider Demographics
NPI:1518005768
Name:LACHETA, EDWIN JOSEPH JR (MS)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:JOSEPH
Last Name:LACHETA
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W S 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-9205
Mailing Address - Country:US
Mailing Address - Phone:217-774-5861
Mailing Address - Fax:217-774-2256
Practice Address - Street 1:2 W ADAMS
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-1943
Practice Address - Country:US
Practice Address - Phone:217-728-8319
Practice Address - Fax:217-774-2256
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL166000206106H00000X
IL180001035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist