Healthcare Provider Details

I. General information

NPI: 1376816132
Provider Name (Legal Business Name): GREGG CALVIRD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CAL CALVIRD

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W BELMONT AVE SUITE 400
CHICAGO IL
60657
US

IV. Provider business mailing address

1256 W BRYN MAWR AVE 2N
CHICAGO IL
60660-4285
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-1310
  • Fax: 773-880-1321
Mailing address:
  • Phone: 773-405-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.007295
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: