Provider Demographics
NPI:1447273412
Name:ELAM, BARB GRACE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:BARB
Middle Name:GRACE
Last Name:ELAM
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 1:139 PINE SHORE DR # 37
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902
Mailing Address - Country:US
Mailing Address - Phone:618-529-3900
Mailing Address - Fax:618-529-0194
Practice Address - Street 1:139 PINE SHORE DR # 37
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62902-7503
Practice Address - Country:US
Practice Address - Phone:618-529-3900
Practice Address - Fax:618-529-0194
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional