MEDICARE: JAMIE GILMARTIN LICENSED CLINICAL PROFESSIONAL COUNSELOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1629725809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMIE GILMARTIN LICENSED CLINICAL PROFESSIONAL COUNSELOR

Provider Business Mailing Address
First Line	:	6835 FORESTVIEW DR APT 3D
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-1634
Country	:	US
Telephone Number	:	708-574-3437
Fax Number	:

Provider Business Practice Location Address
First Line	:	14810 CICERO AVE STE 1D
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-1460
Country	:	US
Telephone Number	:	708-574-3437
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JAMIE GILMARTIN
Credential	:	LCPC
Telephone Number	:	708-574-3437

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	04/04/2022

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