Provider Demographics
NPI:1760750913
Name:LECLERCQ, NORMAN L (MDIV, LMFT)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:L
Last Name:LECLERCQ
Suffix:
Gender:M
Credentials:MDIV, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 177TH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-1722
Mailing Address - Country:US
Mailing Address - Phone:708-895-7310
Mailing Address - Fax:708-895-7602
Practice Address - Street 1:2325 177TH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1722
Practice Address - Country:US
Practice Address - Phone:708-895-7310
Practice Address - Fax:708-895-7602
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000266106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist