NPI 1174909451

Antonio Clarence Ellzey, NCCLCPC

Practitioner Professional Counselor Mokena, IL

Practice location

Address: 9435 Bormet Dr STE 5, Mokena, IL 60448-7401
Phone: (708) 995-7226
Mailing address: 9119s Exchange Ave, Chicago, IL 60617-4225

Registered specialties

Professional Counselor Primary

Behavioral Health & Social Service Providers Taxonomy 101YP2500X Licence EIN-27-4113346 (IL)

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Registry record

NPI: 1174909451
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Aug 2015
Record last updated: 28 Oct 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.