Basic Information
| Provider Information | |||||||||
| NPI: | 1518005768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LACHETA | ||||||||
| FirstName: | EDWIN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 W S 11TH STREET | ||||||||
| Address2: | |||||||||
| City: | SHELBYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625659205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177745861 | ||||||||
| FaxNumber: | 2177742256 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 W ADAMS | ||||||||
| Address2: | |||||||||
| City: | SULLIVAN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619511943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177288319 | ||||||||
| FaxNumber: | 2177742256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IL | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | IL | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.