Provider Demographics
NPI:1043687676
Name:ASHKAZARI, LAILA MARIA (LCPC)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:MARIA
Last Name:ASHKAZARI
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 1:715 SEWARD ST APT 1N
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2940
Mailing Address - Country:US
Mailing Address - Phone:615-525-1054
Mailing Address - Fax:
Practice Address - Street 1:715 SEWARD ST APT 1N
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2940
Practice Address - Country:US
Practice Address - Phone:615-525-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN5361101YP2500X
IL180013916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health