Healthcare Provider Details

I. General information

NPI: 1588208631
Provider Name (Legal Business Name): ELIZABETH ANDERSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 WOODGATE DR
MATTESON IL
60443-1145
US

IV. Provider business mailing address

5715 WOODGATE DR
MATTESON IL
60443-1145
US

V. Phone/Fax

Practice location:
  • Phone: 815-302-8497
  • Fax:
Mailing address:
  • Phone: 815-302-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180017045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: