Provider Demographics
NPI:1154783975
Name:LOZADA-GOODE, LISAURA D (LCPC, BC-DMT)
Entity type:Individual
Prefix:
First Name:LISAURA
Middle Name:D
Last Name:LOZADA-GOODE
Suffix:
Gender:F
Credentials:LCPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 W AGATITE AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3703
Mailing Address - Country:US
Mailing Address - Phone:773-682-1068
Mailing Address - Fax:
Practice Address - Street 1:6007 N SAUGANASH AVE FRNT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5227
Practice Address - Country:US
Practice Address - Phone:773-682-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional