Healthcare Provider Details

I. General information

NPI: 1437868940
Provider Name (Legal Business Name): ASHLEY GUGERTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S LAKE DR
CHESTER IL
62233-2929
US

IV. Provider business mailing address

4401 S LAKE DR
CHESTER IL
62233-2929
US

V. Phone/Fax

Practice location:
  • Phone: 618-598-6040
  • Fax:
Mailing address:
  • Phone: 618-598-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ASHLEY GUGERTY
Title or Position: OWNER/OPERATOR
Credential: LCPC
Phone: 618-598-6040