Healthcare Provider Details

I. General information

NPI: 1720724347
Provider Name (Legal Business Name): ELIZABETH SELPH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W GRAND AVE
CHICAGO IL
60654-7172
US

IV. Provider business mailing address

101 W GRAND AVE
CHICAGO IL
60654-7172
US

V. Phone/Fax

Practice location:
  • Phone: 415-990-3149
  • Fax:
Mailing address:
  • Phone: 415-990-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number178018595
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178017595
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: