1073719407 NPI number — MS. LITZI T HARTLEY LCPC

Table of content: MS. LITZI T HARTLEY LCPC (NPI 1073719407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073719407 NPI number — MS. LITZI T HARTLEY LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTLEY
Provider First Name:
LITZI
Provider Middle Name:
T
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073719407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5818
Provider Second Line Business Mailing Address:
114 E. VAN BUREN AVE.
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60567-5818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-618-9872
Provider Business Mailing Address Fax Number:
630-428-9312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 E VAN BUREN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540-5183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-618-9872
Provider Business Practice Location Address Fax Number:
630-428-9312
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180-005639 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2232737 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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