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NPI Code Detail

MEDICARE: JOE GUSE LCPC

MEDICARE:   JOE  GUSE  LCPC
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
1101YM0800XMental Health Counselor178006014IL
2101YP2500XProfessional Counselor180007738IL

General Provider Information

NPI Number : 1730401621
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOE GUSE LCPC
Provider Business Mailing Address
First Line : 10343 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-2410
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10343 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-2410
Country : US
Telephone Number : 773-238-2828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2010
Last Update Date : 11/07/2011

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Directions to “ JOE GUSE LCPC” Practice Location

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