Provider Demographics
NPI:1265630537
Name:TINGLEY, ELIZABETH CATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CATHERINE
Last Name:TINGLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHIATRY AND PSYCHOLOGY-CARLE PHYSICIAN
Mailing Address - Street 2:1802 S. MATTIS
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821
Mailing Address - Country:US
Mailing Address - Phone:217-365-2856
Mailing Address - Fax:217-365-2856
Practice Address - Street 1:DEPARTMENT OF PSYCHIATRY AND PSYCHOLOGY-CARLE PHYSICIAN
Practice Address - Street 2:1802 S. MATTIS
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821
Practice Address - Country:US
Practice Address - Phone:217-365-2856
Practice Address - Fax:217-365-2856
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016572-1103TC0700X
IL071009597103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical