Provider Demographics
NPI:1104342476
Name:VAN BEEK, LARA ELISABETH (EDS)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:ELISABETH
Last Name:VAN BEEK
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:MS
Other - First Name:LARA
Other - Middle Name:ELISABETH
Other - Last Name:KUBILIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ED S
Mailing Address - Street 1:3450 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2951
Mailing Address - Country:US
Mailing Address - Phone:847-679-9797
Mailing Address - Fax:847-679-1126
Practice Address - Street 1:500 KING ARTHUR WAY
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-739-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool