Healthcare Provider Details

I. General information

NPI: 1912249657
Provider Name (Legal Business Name): ELIZABETH A MARKLEIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E HURON ST 11-100
CHICAGO IL
60611-3197
US

IV. Provider business mailing address

201 E HURON ST 11-100
CHICAGO IL
60611-3197
US

V. Phone/Fax

Practice location:
  • Phone: 312-508-3595
  • Fax: 312-926-3709
Mailing address:
  • Phone: 312-508-3595
  • Fax: 312-926-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180008544
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: