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General NPI Number Information
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NPI Number | 1053863092
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Entity Type | Organization
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Legal Business Name | LIZ GRAY COUNSELING, INC.
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 17900 DIXIE HWY SUITE 11
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City | HOMEWOOD
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State | IL
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Zip | 60430-1754
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Country | US
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Telephone | 708-816-4729
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Fax |
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Provider Business Mailing Address
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Address Line | 66 CORINTH DR
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City | TINLEY PARK
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State | IL
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Zip | 60477-4819
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH GRAY
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Credential | LCSW
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Telephone | 847-899-8320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.016628
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License Number State | IL
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