Healthcare Provider Details

I. General information

NPI: 1992520324
Provider Name (Legal Business Name): ZOE ELIZABETH GRUBBS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 N LAKEWOOD AVE
CHICAGO IL
60657-3215
US

IV. Provider business mailing address

1623 W BELMONT AVE APT 5F
CHICAGO IL
60657-3006
US

V. Phone/Fax

Practice location:
  • Phone: 312-279-9981
  • Fax:
Mailing address:
  • Phone: 612-916-8349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.020763
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: