Provider Demographics
NPI:1578003489
Name:SMITH, ERAN M (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ERAN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ERAN
Other - Middle Name:M
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:IL
Mailing Address - Zip Code:60424-0307
Mailing Address - Country:US
Mailing Address - Phone:815-242-2493
Mailing Address - Fax:
Practice Address - Street 1:13 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6483
Practice Address - Country:US
Practice Address - Phone:815-730-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional