Provider Demographics
NPI:1922666791
Name:KOENIG, ELIZABETH M (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:KOENIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1120 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2287
Mailing Address - Country:US
Mailing Address - Phone:630-377-6613
Mailing Address - Fax:630-377-6225
Practice Address - Street 1:CENTENNIAL COUNSELING CENTER
Practice Address - Street 2:110 E. COUNTRYSIDE PARKWAY, SUITE C
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560
Practice Address - Country:US
Practice Address - Phone:630-553-1600
Practice Address - Fax:630-553-7993
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.104521104100000X
IL149.0257151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker