Provider Demographics
NPI:1982906491
Name:KORACH, LISA REBECCA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:REBECCA
Last Name:KORACH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W HUBBARD ST APT 522
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4970
Mailing Address - Country:US
Mailing Address - Phone:847-977-7782
Mailing Address - Fax:
Practice Address - Street 1:333 W. HUBBARD ST.
Practice Address - Street 2:#522
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654
Practice Address - Country:US
Practice Address - Phone:847-977-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist