Provider Demographics
NPI:1619644721
Name:LELAURIN, ROBERT DEAN JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DEAN
Last Name:LELAURIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 W JACKSON BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3434
Mailing Address - Country:US
Mailing Address - Phone:312-834-7221
Mailing Address - Fax:
Practice Address - Street 1:53 W JACKSON BLVD STE 1615
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3722
Practice Address - Country:US
Practice Address - Phone:312-834-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL178.018015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health