Healthcare Provider Details

I. General information

NPI: 1164123766
Provider Name (Legal Business Name): GAEA COUNSELING CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 N SHEFFIELD AVE # 189
CHICAGO IL
60614-8097
US

IV. Provider business mailing address

2405 N SHEFFIELD AVE # 189
CHICAGO IL
60614-8097
US

V. Phone/Fax

Practice location:
  • Phone: 847-754-8039
  • Fax:
Mailing address:
  • Phone: 847-754-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIE BARNHART
Title or Position: OWNER
Credential:
Phone: 872-205-6167