Provider Demographics
NPI:1538311964
Name:MICHAEL, ELIZABETH V (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:V
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 W ALGONQUIN RD
Mailing Address - Street 2:SUITE 107A
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9406
Mailing Address - Country:US
Mailing Address - Phone:847-372-5046
Mailing Address - Fax:847-458-0071
Practice Address - Street 1:2971 W ALGONQUIN RD
Practice Address - Street 2:SUITE 107A
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9406
Practice Address - Country:US
Practice Address - Phone:847-372-5046
Practice Address - Fax:847-458-0071
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-0059-69103TB0200X
IL071-005969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral