Provider Demographics
NPI:1588745194
Name:LAKE-COOK PSYCHOLOGIST AND COUNSELING
Entity type:Organization
Organization Name:LAKE-COOK PSYCHOLOGIST AND COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-577-1501
Mailing Address - Street 1:3285 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1564
Mailing Address - Country:US
Mailing Address - Phone:847-577-1501
Mailing Address - Fax:847-577-3858
Practice Address - Street 1:3285 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1564
Practice Address - Country:US
Practice Address - Phone:847-577-1501
Practice Address - Fax:847-577-3858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty