Provider Demographics
NPI:1457533994
Name:HUMPHREY, ELAINE A (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:A
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:A
Other - Last Name:BELOKON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:GENESCO
Mailing Address - State:IL
Mailing Address - Zip Code:61254
Mailing Address - Country:US
Mailing Address - Phone:309-944-3203
Mailing Address - Fax:
Practice Address - Street 1:137 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443
Practice Address - Country:US
Practice Address - Phone:309-852-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180 001100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional