Provider Demographics
NPI:1588019558
Name:AU, EDMUND (LCPC)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:
Last Name:AU
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 9TH ST
Mailing Address - Street 2:APT A
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1580
Mailing Address - Country:US
Mailing Address - Phone:217-671-0383
Mailing Address - Fax:
Practice Address - Street 1:2100 5TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-9115
Practice Address - Country:US
Practice Address - Phone:217-732-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional