Provider Demographics
NPI:1528382017
Name:KEZDI-HAMZELOO, LAURA (LCPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KEZDI-HAMZELOO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3909
Mailing Address - Country:US
Mailing Address - Phone:847-590-0043
Mailing Address - Fax:
Practice Address - Street 1:519 S. EDWARD STREET
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3945
Practice Address - Country:US
Practice Address - Phone:847-590-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional