Provider Demographics
NPI:1790835791
Name:LAU, MICHAEL F (LCPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:F
Last Name:LAU
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 GOODING ST
Mailing Address - Street 2:
Mailing Address - City:LASALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301
Mailing Address - Country:US
Mailing Address - Phone:815-224-4522
Mailing Address - Fax:815-223-8055
Practice Address - Street 1:146 GOODING ST
Practice Address - Street 2:
Practice Address - City:LASALLE
Practice Address - State:IL
Practice Address - Zip Code:61301
Practice Address - Country:US
Practice Address - Phone:815-224-4522
Practice Address - Fax:815-223-8055
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002652101YM0800X
IL180.002652101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health