Provider Demographics
NPI:1720550999
Name:GARWOOD-MARTIN, LARA (LCPC)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:GARWOOD-MARTIN
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 1:715 E GOLF RD STE 200A1A
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4597
Mailing Address - Country:US
Mailing Address - Phone:847-737-9191
Mailing Address - Fax:
Practice Address - Street 1:715 E GOLF RD STE 200A1A
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4597
Practice Address - Country:US
Practice Address - Phone:847-737-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011756101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178011756OtherILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION