Provider Demographics
NPI:1639443641
Name:LAGACY, KARIN (PSYD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:LAGACY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 BUTTERFIELD RD STE 138S
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1244
Mailing Address - Country:US
Mailing Address - Phone:630-537-0124
Mailing Address - Fax:
Practice Address - Street 1:2625 BUTTERFIELD RD STE 138S
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1244
Practice Address - Country:US
Practice Address - Phone:630-537-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007728101Y00000X
101YP2500X
IL071008484103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional