Provider Demographics
NPI:1265494298
Name:WALDEN, ELMYRA (MA LCPC)
Entity Type:Individual
Prefix:
First Name:ELMYRA
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0 NORTH 479 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185
Mailing Address - Country:US
Mailing Address - Phone:630-881-2525
Mailing Address - Fax:
Practice Address - Street 1:140 NORTH OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185
Practice Address - Country:US
Practice Address - Phone:630-881-2525
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232460OtherBLUE CROSS BLUE SHIELD IL