Individual
MR. ANTONIO CLARENCE ELLZEY SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NCC, LCPC
Contact information
Practice address
9435 BORMET DR STE 5, MOKENA, IL 60448-7401
(708) 995-7226
Mailing address
9119S EXCHANGE AVE, CHICAGO, IL 60617-4225
(773) 768-5000
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
EIN-27-4113346
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205137346
GROUP NPI
IL
Enumeration date
08/10/2015
Last updated
10/28/2015
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