| Doctor Name: | MR. LARRY EHRETSMAN |
| NPI Number: | 1093156127 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.C.P.C. |
| License Number: | 180.003642 |
| Business Practice Address: | 17255 Oak Park Ave Tinley Park, IL - 604773401 |
| Business Phone Number: | 7086334533 |
| Business Fax Number: | 7086334531 |
| Mailing Address: | 12825 E Tanglewood Cir, PALOS PARK |
| State: | IL |
| Postal Code: | 604641619 |
| Phone Number: | 7084369534 |
| Fax Number: | |
| NPI Enumeration Date: | 07/17/2013 |
| NPI Last Update Date: | 07/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 180.003642 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |