Provider Demographics
NPI:1477561116
Name:NYTHER, ELWOOD P (LCSW, MAC)
Entity Type:Individual
Prefix:
First Name:ELWOOD
Middle Name:P
Last Name:NYTHER
Suffix:
Gender:M
Credentials:LCSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 S RHODES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5005
Mailing Address - Country:US
Mailing Address - Phone:773-783-5231
Mailing Address - Fax:866-240-8885
Practice Address - Street 1:8251 S RHODES AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5005
Practice Address - Country:US
Practice Address - Phone:773-818-9607
Practice Address - Fax:866-240-8885
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149004694101YA0400X, 101YM0800X, 1041C0700X
IL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral