Healthcare Provider Details

I. General information

NPI: 1700538881
Provider Name (Legal Business Name): JAMES JOSEPH GOMEZ LCPC, LMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 W MONTROSE AVE STE 102
CHICAGO IL
60618-1562
US

IV. Provider business mailing address

2650 W MONTROSE AVE STE 102
CHICAGO IL
60618-1562
US

V. Phone/Fax

Practice location:
  • Phone: 733-377-5261
  • Fax:
Mailing address:
  • Phone: 733-377-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number108900
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016085
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: