Healthcare Provider Details

I. General information

NPI: 1730401621
Provider Name (Legal Business Name): JOE GUSE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10343 S WESTERN AVE
CHICAGO IL
60643-2410
US

IV. Provider business mailing address

10343 S WESTERN AVE
CHICAGO IL
60643-2410
US

V. Phone/Fax

Practice location:
  • Phone: 773-238-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178006014
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007738
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: