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Mr. Antonio Clarence Ellzey SR., NCC,LCPC
Professional Counselor in Mokena, Illinois
NPI 1174909451

Antonio Clarence Ellzey SR. is a Professional Counselor based in Chicago, IL and is specialized in Professional. Antonio Clarence Ellzey SR. practices in Mokena, IL and has the professional credentials of NCC,LCPC. The NPI Number for Antonio Clarence Ellzey SR. is 1174909451 and holds a License No. EIN-27-4113346 (Illinois).

The current practice location address for Antonio Clarence Ellzey SR. is 9435 Bormet Dr Ste 5, Mokena, IL and can be reached out via phone at 708-995-7226.

Location: 9435 Bormet Dr Ste 5, Mokena, IL, 60617-4225
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1174909451
Provider Name
Antonio Clarence Ellzey SR.
Credential
NCC,LCPC
Provider Entity Type
Individual
Gender
Male
Address
9435 Bormet Dr Ste 5, Mokena, IL, 60617-4225
Phone Number
708-995-7226
Fax Number
Provider Enumeration Date
08/10/2015
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1205137346 01 IL GROUP NPI
institution
Provider Business Practice Location Address Details
Address
9435 Bormet Dr Ste 5
City
Mokena
State
Illinois
Zip
60448-7401
Phone Number
708-995-7226
Fax Number
person
Provider Business Mailing Address Details
Address
9435 Bormet Dr Ste 5
City
Mokena
State
Illinois
Zip
60448-7401
Phone Number
708-995-7226
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
101YP2500X
License No.
EIN-27-4113346 (Illinois)
Definition
Definition to come...
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