Provider Demographics
NPI:1558833178
Name:CARR, LEE (LCPC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:CARR
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 1:1360 N LAKE SHORE DR APT 808
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8449
Mailing Address - Country:US
Mailing Address - Phone:630-479-2501
Mailing Address - Fax:
Practice Address - Street 1:1360 N LAKE SHORE DR APT 808
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-8449
Practice Address - Country:US
Practice Address - Phone:630-479-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2329731101YS0200X
IL180.011849101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2501Medicaid