Provider Demographics
NPI:1295774271
Name:KEEL, LISA LEVY (PHD, MA, LCPC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LEVY
Last Name:KEEL
Suffix:
Gender:F
Credentials:PHD, MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 524
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-0524
Mailing Address - Country:US
Mailing Address - Phone:847-548-0492
Mailing Address - Fax:847-548-0537
Practice Address - Street 1:1170 E BELVIDERE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2061
Practice Address - Country:US
Practice Address - Phone:847-548-0492
Practice Address - Fax:847-548-0537
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932460OtherBC/BS