Antonio Clarence Ellzey Sr., NCC, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

EIN-27-4113346 Issued in IL

Practice address

9435 Bormet Dr Ste 5
Mokena, IL 60448-7401

Phone

(708) 995-7226

NPI assigned

Aug 10, 2015

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Great Changes Counseling Services, P.C.

  • Clinical Social Worker
  • Mokena, IL
  • NPI 1205137346
  NPD (past)
• Intertwined

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1205168424

  Professional

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1174909451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9119S EXCHANGE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174225",
            "telephone_number": "773-768-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9435 BORMET DR STE 5",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604487401",
            "telephone_number": "708-995-7226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLZEY",
        "first_name": "ANTONIO",
        "middle_name": "CLARENCE",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "NCC, LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-10",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "EIN-27-4113346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1205137346",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Mokena, IL
• Providers in Mokena, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.