Basic Information
| Provider Information | |||||||||
| NPI: | 1629194501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCELLIN | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BS,CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 S RAND ROAD | ||||||||
| Address2: | |||||||||
| City: | VILLA PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601813148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308336033 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 675 VARSITY DRIVE | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601208176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477412600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 19967 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.