Provider Demographics
NPI:1972044634
Name:SANTEFORT, LAUREN (LCPC)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:
Last Name:SANTEFORT
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 1:19436 BARON RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9289
Mailing Address - Country:US
Mailing Address - Phone:708-227-5823
Mailing Address - Fax:
Practice Address - Street 1:17255 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3401
Practice Address - Country:US
Practice Address - Phone:708-633-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional