Provider Demographics
NPI:1174097406
Name:LAURA KEZDI-HAMZELOO, LCPC
Entity type:Organization
Organization Name:LAURA KEZDI-HAMZELOO, LCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEZDI-HAMZELOO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-558-2868
Mailing Address - Street 1:519 S EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3909
Mailing Address - Country:US
Mailing Address - Phone:224-558-2868
Mailing Address - Fax:847-590-0043
Practice Address - Street 1:3365 N ARLINGTON HEIGHTS RD STE L
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7700
Practice Address - Country:US
Practice Address - Phone:224-558-2868
Practice Address - Fax:847-590-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL297586104-01Medicaid