Provider Demographics
NPI:1679890362
Name:LEWIS, ELIZABETH (LCPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19530 KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1778
Mailing Address - Country:US
Mailing Address - Phone:708-799-2200
Mailing Address - Fax:
Practice Address - Street 1:19530 KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1778
Practice Address - Country:US
Practice Address - Phone:708-799-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004834101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor