Provider Demographics
NPI:1932970324
Name:LAURICH, DAVID RAYMOND (LCPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RAYMOND
Last Name:LAURICH
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 1:16723 S SUNSET RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-7677
Mailing Address - Country:US
Mailing Address - Phone:815-474-6657
Mailing Address - Fax:
Practice Address - Street 1:1500 EISENHOWER LN STE 900
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2135
Practice Address - Country:US
Practice Address - Phone:630-428-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015537101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor