Provider Demographics
NPI:1336654219
Name:SIEGAL ELI-GERS THERAPY AND COUNSELING LLC
Entity Type:Organization
Organization Name:SIEGAL ELI-GERS THERAPY AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIEGAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELI-GERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-868-2140
Mailing Address - Street 1:1609 SHERMAN AVE STE 318
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3753
Mailing Address - Country:US
Mailing Address - Phone:847-868-2140
Mailing Address - Fax:847-201-2853
Practice Address - Street 1:1609 SHERMAN AVE STE 318
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3753
Practice Address - Country:US
Practice Address - Phone:847-868-2140
Practice Address - Fax:847-201-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0124511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty