Healthcare Provider Details

I. General information

NPI: 1841732625
Provider Name (Legal Business Name): EBONY OLIPHANT LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 FLORENCE AVE
EVANSTON IL
60202-1124
US

IV. Provider business mailing address

1129 FLORENCE AVE
EVANSTON IL
60202-1124
US

V. Phone/Fax

Practice location:
  • Phone: 224-269-0286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.012561
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: