Provider Demographics
NPI:1013197318
Name:KETRING, ELAINE ANTHONY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ANTHONY
Last Name:KETRING
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 1:208 N PERSHING ST UNIT 333
Mailing Address - Street 2:
Mailing Address - City:ENERGY
Mailing Address - State:IL
Mailing Address - Zip Code:62933-6118
Mailing Address - Country:US
Mailing Address - Phone:618-942-2516
Mailing Address - Fax:618-942-2516
Practice Address - Street 1:404 N PERSHING ST
Practice Address - Street 2:
Practice Address - City:ENERGY
Practice Address - State:IL
Practice Address - Zip Code:62933-3530
Practice Address - Country:US
Practice Address - Phone:618-942-2516
Practice Address - Fax:618-942-2516
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003332101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor