Provider Demographics
NPI:1134429855
Name:BROWN, LAURA (MSED, LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 W CHICAGO AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5127
Mailing Address - Country:US
Mailing Address - Phone:312-743-1638
Mailing Address - Fax:
Practice Address - Street 1:1615 W CHICAGO AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5127
Practice Address - Country:US
Practice Address - Phone:312-743-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional