| Doctor Name: | MR. ANTONIO CLARENCE ELLZEY |
| NPI Number: | 1174909451 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NCC, LCPC |
| License Number: | EIN-27-4113346 |
| Business Practice Address: | 9435 Bormet Dr Ste 5 Mokena, IL - 604487401 |
| Business Phone Number: | 7089957226 |
| Business Fax Number: | |
| Mailing Address: | 9119s Exchange Ave, CHICAGO |
| State: | IL |
| Postal Code: | 606174225 |
| Phone Number: | 7737685000 |
| Fax Number: | |
| NPI Enumeration Date: | 08/10/2015 |
| NPI Last Update Date: | 10/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | EIN-27-4113346 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |