Provider Demographics
NPI:1952916322
Name:SKELTON, ELLE (BC-TMH, LCPC,)
Entity Type:Individual
Prefix:
First Name:ELLE
Middle Name:
Last Name:SKELTON
Suffix:
Gender:F
Credentials:BC-TMH, LCPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 N SEELEY AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3363
Mailing Address - Country:US
Mailing Address - Phone:312-841-7270
Mailing Address - Fax:
Practice Address - Street 1:2219 N SEELEY AVE APT 3F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-3363
Practice Address - Country:US
Practice Address - Phone:312-841-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health