Provider Demographics
NPI:1831538230
Name:LEVENS, LISA P (LCPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:P
Last Name:LEVENS
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:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-0942
Mailing Address - Country:US
Mailing Address - Phone:773-484-8343
Mailing Address - Fax:
Practice Address - Street 1:3717 N RAVENSWOOD AVE STE 140
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1164
Practice Address - Country:US
Practice Address - Phone:773-484-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.002415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional