Provider Demographics
NPI:1811298300
Name:MERTES, LAURA JEAN M (LPC)
Entity type:Individual
Prefix:
First Name:LAURA JEAN
Middle Name:M
Last Name:MERTES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N LARKIN AVE
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3438
Mailing Address - Country:US
Mailing Address - Phone:815-730-8900
Mailing Address - Fax:815-630-4747
Practice Address - Street 1:815 N LARKIN AVE
Practice Address - Street 2:SUITE 104B
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3438
Practice Address - Country:US
Practice Address - Phone:815-730-8900
Practice Address - Fax:815-630-4747
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional