Provider Demographics
NPI:1073719407
Name:HARTLEY, LITZI T (LCPC)
Entity Type:Individual
Prefix:MS
First Name:LITZI
Middle Name:T
Last Name:HARTLEY
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:PO BOX 5818
Mailing Address - Street 2:114 E. VAN BUREN AVE.
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-5818
Mailing Address - Country:US
Mailing Address - Phone:630-618-9872
Mailing Address - Fax:630-428-9312
Practice Address - Street 1:114 E VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5183
Practice Address - Country:US
Practice Address - Phone:630-618-9872
Practice Address - Fax:630-428-9312
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232737OtherBLUE CROSS BLUE SHIELD