Provider Demographics
NPI:1336533314
Name:KING, CLAUDE LUCAS (LCPC, AMFT)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:LUCAS
Last Name:KING
Suffix:
Gender:M
Credentials:LCPC, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6235 S MAJOR AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-4522
Mailing Address - Country:US
Mailing Address - Phone:630-251-4346
Mailing Address - Fax:
Practice Address - Street 1:6235 S MAJOR AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638
Practice Address - Country:US
Practice Address - Phone:630-251-4346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL178.010851101YP2500X
IL208.000379106H00000X
IL180.011219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist