Healthcare Provider Details

I. General information

NPI: 1861242539
Provider Name (Legal Business Name): ELIZABETH M EATON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W BALTIMORE ST
WILMINGTON IL
60481-1292
US

IV. Provider business mailing address

305 E SHORT DR
COAL CITY IL
60416-4108
US

V. Phone/Fax

Practice location:
  • Phone: 815-331-1124
  • Fax: 855-644-3643
Mailing address:
  • Phone: 815-600-1353
  • Fax: 855-644-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015926
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: