Provider Demographics
NPI:1922577949
Name:ELIZABETH WILTON THERAPY, LLC
Entity Type:Organization
Organization Name:ELIZABETH WILTON THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-396-8607
Mailing Address - Street 1:2901A CENTRAL ST STE 3
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:773-396-8607
Mailing Address - Fax:
Practice Address - Street 1:2901A CENTRAL ST STE 3
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:773-396-8607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty