Provider Demographics
NPI:1609051622
Name:M LAKIND LLC
Entity Type:Organization
Organization Name:M LAKIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:LAKIND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-644-1104
Mailing Address - Street 1:2740 MARCY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1139
Mailing Address - Country:US
Mailing Address - Phone:847-864-2239
Mailing Address - Fax:
Practice Address - Street 1:1500 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5340
Practice Address - Country:US
Practice Address - Phone:847-644-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty