Healthcare Provider Details

I. General information

NPI: 1013175462
Provider Name (Legal Business Name): ELIZABETH ANN WHITEHEAD LCPC, LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIZ WHITEHEAD LCPC, LPC-MHSP

II. Dates (important events)

Enumeration Date: 05/31/2008
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10181 AZALEA DR
CROWN POINT IN
46307-5352
US

IV. Provider business mailing address

10181 AZALEA DR
CROWN POINT IN
46307-5352
US

V. Phone/Fax

Practice location:
  • Phone: 219-627-4002
  • Fax: 219-627-4002
Mailing address:
  • Phone: 219-627-4002
  • Fax: 219-627-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.004723
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.013196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: