Provider Demographics
NPI:1487284527
Name:POETZING, ELIZABETH (LCPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:POETZING
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 1:3232 W BELLE PLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2302
Mailing Address - Country:US
Mailing Address - Phone:773-206-5486
Mailing Address - Fax:
Practice Address - Street 1:3139 N LINCOLN AVE # 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3114
Practice Address - Country:US
Practice Address - Phone:773-206-5486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty