MEDICARE: GISELLA FOTO

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	101YM0800X	Mental Health Counselor	180015314	IL

General Provider Information

NPI Number	:	1669251245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISELLA FOTO

Provider Business Mailing Address
First Line	:	4318 W CRYSTAL LAKE RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4210
Country	:	US
Telephone Number	:	815-331-8381
Fax Number	:	815-331-8362

Provider Business Practice Location Address
First Line	:	4318 W CRYSTAL LAKE RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4210
Country	:	US
Telephone Number	:	815-331-8381
Fax Number	:	815-331-8362

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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