Provider Demographics
NPI:1912795352
Name:LAKES, MEAGHAN (MED, LCPC)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:LAKES
Suffix:
Gender:
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 S CALUMET AVE APT 3S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-2202
Mailing Address - Country:US
Mailing Address - Phone:872-228-7225
Mailing Address - Fax:
Practice Address - Street 1:4010 S CALUMET AVE APT 3S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-2202
Practice Address - Country:US
Practice Address - Phone:872-228-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018033173101Y00000X, 101YP2500X
IL180015814101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional