Provider Demographics
NPI:1760266423
Name:LASLEY PSYCH SERVICES PLLC
Entity Type:Organization
Organization Name:LASLEY PSYCH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCP
Authorized Official - Phone:773-573-0884
Mailing Address - Street 1:314 LEE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-4546
Mailing Address - Country:US
Mailing Address - Phone:773-573-0884
Mailing Address - Fax:
Practice Address - Street 1:708 CHURCH ST STE 252
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3840
Practice Address - Country:US
Practice Address - Phone:773-570-0128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty