Healthcare Provider Details

I. General information

NPI: 1720709405
Provider Name (Legal Business Name): ELIZABETH CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N DUNTON AVE
ARLINGTON HEIGHTS IL
60004-5915
US

IV. Provider business mailing address

614 KENWOOD AVE
WEST CHICAGO IL
60185-3228
US

V. Phone/Fax

Practice location:
  • Phone: 847-524-8800
  • Fax:
Mailing address:
  • Phone: 630-402-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: