Provider Demographics
NPI:1902099781
Name:TEJADA, LAURA J (LMFT, LCPC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:TEJADA
Suffix:
Gender:F
Credentials:LMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 N MICHIGAN AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3959
Mailing Address - Country:US
Mailing Address - Phone:773-609-0622
Mailing Address - Fax:
Practice Address - Street 1:444 N MICHIGAN AVE STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3959
Practice Address - Country:US
Practice Address - Phone:773-609-0622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC21485101YM0800X
IL180.008976101YM0800X
KSLCPC300101YM0800X
AZLMFT15847106H00000X
KSLMFT1002106H00000X
IL166.000927106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health