Provider Demographics
NPI:1710612197
Name:MAYER, LUCRETIA M (LPC)
Entity Type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:M
Last Name:MAYER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LUCRETIA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1 E ERIE ST STE 525-2584
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2740
Mailing Address - Country:US
Mailing Address - Phone:773-807-2072
Mailing Address - Fax:
Practice Address - Street 1:1 E ERIE ST STE 525-2584
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2740
Practice Address - Country:US
Practice Address - Phone:773-807-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180013134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional