Provider Demographics
NPI:1932485539
Name:PRICE, LETERIA RS (LCPC, LPHA)
Entity type:Individual
Prefix:MRS
First Name:LETERIA
Middle Name:RS
Last Name:PRICE
Suffix:
Gender:F
Credentials:LCPC, LPHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1218
Mailing Address - Country:US
Mailing Address - Phone:708-762-0110
Mailing Address - Fax:
Practice Address - Street 1:115 N MARION ST STE 6
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1503
Practice Address - Country:US
Practice Address - Phone:708-762-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional