Provider Demographics
NPI:1639636889
Name:RICHTER, LAUREN M (LCPC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:RICHTER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12603 STATE ROUTE 143
Mailing Address - Street 2:STE. G PMB 211
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-5635
Mailing Address - Country:US
Mailing Address - Phone:618-206-5013
Mailing Address - Fax:
Practice Address - Street 1:1008 TROY OFALLON RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2400
Practice Address - Country:US
Practice Address - Phone:618-972-1568
Practice Address - Fax:618-205-3561
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014631101YP2500X
IL180.013891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicaid