Provider Demographics
NPI:1184384281
Name:BALES, ELIZABETH (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BALES
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28373 DAVIS PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-1437
Mailing Address - Country:US
Mailing Address - Phone:630-261-9220
Mailing Address - Fax:
Practice Address - Street 1:28373 DAVIS PKWY STE 500
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-1437
Practice Address - Country:US
Practice Address - Phone:630-261-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012354101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor