Provider Demographics
NPI:1053138115
Name:ELISE LANKER COUNSELING, PLLC
Entity type:Organization
Organization Name:ELISE LANKER COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-375-8329
Mailing Address - Street 1:1717 W KIRBY AVE UNIT A-09
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5507
Mailing Address - Country:US
Mailing Address - Phone:217-375-8329
Mailing Address - Fax:
Practice Address - Street 1:1102 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-2745
Practice Address - Country:US
Practice Address - Phone:217-375-8329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)