Provider Demographics
NPI:1760698849
Name:LALIC, MICHAEL (LCSW, LMFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LALIC
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 W 99TH PL
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5402
Mailing Address - Country:US
Mailing Address - Phone:219-663-2651
Mailing Address - Fax:
Practice Address - Street 1:119 W 86TH AVE
Practice Address - Street 2:SUITE 119S
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7063
Practice Address - Country:US
Practice Address - Phone:219-756-8944
Practice Address - Fax:219-756-8945
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002925A1041C0700X
IN35000047A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist