Healthcare Provider Details

I. General information

NPI: 1891380945
Provider Name (Legal Business Name): LEONIDAS GKIMISIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 W NORTH AVE STE 2B
CHICAGO IL
60647-5413
US

IV. Provider business mailing address

2045 W NORTH AVE STE 2B
CHICAGO IL
60647-5413
US

V. Phone/Fax

Practice location:
  • Phone: 708-274-7334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4604
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016598
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: