Provider Demographics
NPI:1477179604
Name:AZRIEL, ELYSE (MS, MA, CRC, LPC)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:AZRIEL
Suffix:
Gender:F
Credentials:MS, MA, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SOUTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-3258
Mailing Address - Country:US
Mailing Address - Phone:847-922-3705
Mailing Address - Fax:
Practice Address - Street 1:250 E SUPERIOR ST STE 5-2221
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-472-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013454101Y00000X
IL00270804225C00000X
IL247.000193170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor