Individual
ELLI BANES CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
LPC
Contact information
Practice address
800 ROOSEVELT RD STE E220, GLEN ELLYN, IL 60137-5868
(815) 980-1153
Mailing address
6991 DAGGERT RD, MOUNT CARROLL, IL 61053-9132
(815) 980-1153
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
178.021007
IL
Other
Enumeration date
03/10/2025
Last updated
03/10/2025
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