Healthcare Provider Details

I. General information

NPI: 1003682402
Provider Name (Legal Business Name): ELIZABETH ANNE CIUKAJ MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 167TH ST
TINLEY PARK IL
60477-2501
US

IV. Provider business mailing address

12058 ARLENE DR
HOMER GLEN IL
60491-6811
US

V. Phone/Fax

Practice location:
  • Phone: 708-414-6117
  • Fax:
Mailing address:
  • Phone: 708-280-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.019650
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: