Provider Demographics
NPI:1104558147
Name:ELAYYAN, TERESA (CADC, ICDVP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:ELAYYAN
Suffix:
Gender:F
Credentials:CADC, ICDVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16728 JULIE ANN LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5651
Mailing Address - Country:US
Mailing Address - Phone:170-894-0232
Mailing Address - Fax:
Practice Address - Street 1:4239 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2623
Practice Address - Country:US
Practice Address - Phone:708-529-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36010101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)