Provider Demographics
NPI:1104250844
Name:GARMON, LISA GAIL (LPC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:GAIL
Last Name:GARMON
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 1:345 S PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-3226
Mailing Address - Country:US
Mailing Address - Phone:630-260-7600
Mailing Address - Fax:630-462-7076
Practice Address - Street 1:345 S PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-3226
Practice Address - Country:US
Practice Address - Phone:630-260-7611
Practice Address - Fax:630-462-7076
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.008227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional