Provider Demographics
NPI:1972128825
Name:ELIZABETH HEID COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:ELIZABETH HEID COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-205-0024
Mailing Address - Street 1:15 CAMERON CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-8330
Mailing Address - Country:US
Mailing Address - Phone:309-212-1004
Mailing Address - Fax:
Practice Address - Street 1:2103 E WASHINGTON ST BLDG 1
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4310
Practice Address - Country:US
Practice Address - Phone:309-205-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNPI1Other1215400791