Provider Demographics
NPI:1962526863
Name:TOLLY, ELIZABETH PALMER (LCPC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:PALMER
Last Name:TOLLY
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 1:13 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-7592
Mailing Address - Country:US
Mailing Address - Phone:815-932-2346
Mailing Address - Fax:815-932-2346
Practice Address - Street 1:1475 HARVARD DR
Practice Address - Street 2:10A
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-8451
Practice Address - Country:US
Practice Address - Phone:815-592-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional