Individual
CORLISS IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
2520 ELISHA AVE, ZION, IL 60099
(224) 707-0146
Mailing address
206 CEDAR AVE UNIT 664, LAKE VILLA, IL 60046-4629
(847) 912-4991
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.009200
IL
Other
Enumeration date
12/30/2020
Last updated
12/09/2021
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