Provider Demographics
NPI:1689121428
Name:LAURY, CARLA RUTH (LCPC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:RUTH
Last Name:LAURY
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 1:835 PEARSON ST APT 405
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6409
Mailing Address - Country:US
Mailing Address - Phone:847-431-5077
Mailing Address - Fax:
Practice Address - Street 1:415 W GOLF RD STE 59B
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3923
Practice Address - Country:US
Practice Address - Phone:847-305-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional