MEDICARE: ELISA JULIA LEE LCPC, NBCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	178013267	IL
2	101YP2500X	Professional Counselor	180013779	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215384292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA JULIA LEE LCPC, NBCC

Provider Business Mailing Address
First Line	:	PO BOX 388556
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-8556
Country	:	US
Telephone Number	:	708-304-3010
Fax Number	:	708-575-5333

Provider Business Practice Location Address
First Line	:	6815 W 63RD ST STE 7
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4066
Country	:	US
Telephone Number	:	708-304-3010
Fax Number	:	708-575-5333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	03/27/2023

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