Provider Demographics
NPI:1629134226
Name:ELICK, MAUREEN (LCPC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:ELICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 WINDSOR RD
Mailing Address - Street 2:PO BOX 15957
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4280
Mailing Address - Country:US
Mailing Address - Phone:815-636-0658
Mailing Address - Fax:815-643-2739
Practice Address - Street 1:1752 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4280
Practice Address - Country:US
Practice Address - Phone:815-636-0658
Practice Address - Fax:815-643-2739
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional