Provider Demographics
NPI:1942641402
Name:LAUGHLIN, PHYLLIS I (LCPC)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:I
Last Name:LAUGHLIN
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 1:6601 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1005
Mailing Address - Country:US
Mailing Address - Phone:773-629-4730
Mailing Address - Fax:708-608-8943
Practice Address - Street 1:6601 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1005
Practice Address - Country:US
Practice Address - Phone:773-629-4730
Practice Address - Fax:708-608-8943
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.005008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional