Healthcare Provider Details

I. General information

NPI: 1477561116
Provider Name (Legal Business Name): ELWOOD P NYTHER LCSW, MAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 S RHODES AVE
CHICAGO IL
60619-5005
US

IV. Provider business mailing address

8251 S RHODES AVE
CHICAGO IL
60619-5005
US

V. Phone/Fax

Practice location:
  • Phone: 773-818-9607
  • Fax: 866-240-8885
Mailing address:
  • Phone: 773-783-5231
  • Fax: 866-240-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number149004694
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149004694
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149004694
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: