Healthcare Provider Details

I. General information

NPI: 1750881611
Provider Name (Legal Business Name): MARTHA ELAINE ERBES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2018
Last Update Date: 02/20/2025
Certification Date: 02/07/2025
Deactivation Date: 02/07/2025
Reactivation Date: 02/20/2025

III. Provider practice location address

1473 RING RD
CALUMET CITY IL
60409-5459
US

IV. Provider business mailing address

1805 ARBOR LN APT 104
CREST HILL IL
60403-2233
US

V. Phone/Fax

Practice location:
  • Phone: 708-862-8156
  • Fax:
Mailing address:
  • Phone: 708-826-9094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178012803
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: