Provider Demographics
NPI:1982398590
Name:BELKNAP, ELISE (PHD, LPC)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:BELKNAP
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4853
Mailing Address - Country:US
Mailing Address - Phone:626-390-8523
Mailing Address - Fax:
Practice Address - Street 1:1701 S PROSPECT AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7054
Practice Address - Country:US
Practice Address - Phone:217-840-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional