Provider Demographics
NPI:1477279651
Name:OTTE PRACTICE PLLC
Entity Type:Organization
Organization Name:OTTE PRACTICE PLLC
Other - Org Name:ELLIE MENTAL HEALTH - NAPERVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTTE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-401-1428
Mailing Address - Street 1:1804 N NAPER BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8830
Mailing Address - Country:US
Mailing Address - Phone:708-297-1723
Mailing Address - Fax:
Practice Address - Street 1:1804 N NAPER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8830
Practice Address - Country:US
Practice Address - Phone:708-297-1723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child