Provider Demographics
NPI:1043083744
Name:BLAHA, ELIZABETH FRANCES (LCPC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FRANCES
Last Name:BLAHA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17758 S MITCHELL LN
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4754
Mailing Address - Country:US
Mailing Address - Phone:708-703-0171
Mailing Address - Fax:
Practice Address - Street 1:17758 S MITCHELL LN
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-4754
Practice Address - Country:US
Practice Address - Phone:708-703-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional