Provider Demographics
NPI:1952707051
Name:ALEXOFF, LISA (LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ALEXOFF
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 1:501 N RIVERSIDE DR STE 111
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5918
Mailing Address - Country:US
Mailing Address - Phone:847-962-1639
Mailing Address - Fax:224-944-0628
Practice Address - Street 1:501 N RIVERSIDE DR STE 111
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5918
Practice Address - Country:US
Practice Address - Phone:847-962-1639
Practice Address - Fax:224-944-0628
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010922101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1952707051OtherNPI