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General NPI Number Information
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NPI Number | 1942352018
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Entity Type | Individual
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Provider Name | MISS ESMARIE ELLIOTT
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | 6121 S SANGAMON ST
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City | CHICAGO
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State | IL
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Zip | 60621-2003
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Country | US
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Telephone | 773-488-7251
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Fax | 773-488-7258
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Provider Business Mailing Address
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Address Line | 14518 S WABASH AVE
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City | RIVERDALE
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State | IL
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Zip | 60827-2844
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Country | US
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Telephone | 708-841-6240
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Fax | 708-880-1138
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180003629
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License Number State | IL
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