Provider Demographics
NPI:1891152955
Name:BLOCK, LISA S (LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:BLOCK
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 1:6732 NANTUCKET CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4014
Mailing Address - Country:US
Mailing Address - Phone:847-224-1811
Mailing Address - Fax:
Practice Address - Street 1:740 FLORSHEIM DR STE 205
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3712
Practice Address - Country:US
Practice Address - Phone:847-485-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014449101YM0800X, 101YP2500X
IL2290678101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool