| Doctor Name: | ELIZABETH JEREMIAH |
| NPI Number: | 1023408200 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, QMHP, LCPC, LPHA |
| License Number: | 180.009474 |
| Business Practice Address: | 50 Northgate Industrial Dr Granite City, IL - 620406805 |
| Business Phone Number: | 6187891959 |
| Business Fax Number: | |
| Mailing Address: | 3809 W Main St, BELLEVILLE |
| State: | IL |
| Postal Code: | 622266003 |
| Phone Number: | 6183037544 |
| Fax Number: | |
| NPI Enumeration Date: | 01/27/2015 |
| NPI Last Update Date: | 01/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 180.009474 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |