Provider Demographics
NPI:1487349460
Name:KUBAN, LISA (LCPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KUBAN
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 1:9006 S MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-1230
Mailing Address - Country:US
Mailing Address - Phone:708-297-4108
Mailing Address - Fax:
Practice Address - Street 1:10661 S ROBERTS RD STE 101
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1992
Practice Address - Country:US
Practice Address - Phone:708-297-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014587101YM0800X
IL180.014587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health