Provider Demographics
NPI:1609836915
Name:LEVANTI THOMAS, LISA J (LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:LEVANTI THOMAS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:LEVANTI THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:107 SHILOH DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-7301
Mailing Address - Country:US
Mailing Address - Phone:618-242-6944
Mailing Address - Fax:618-242-6726
Practice Address - Street 1:107 SHILOH DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-7301
Practice Address - Country:US
Practice Address - Phone:618-242-6944
Practice Address - Fax:618-242-6726
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional