Healthcare Provider Details

I. General information

NPI: 1972407005
Provider Name (Legal Business Name): ADRIAN GOMEZ REYES MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 W NORTH AVE FL 1
CHICAGO IL
60639-3861
US

IV. Provider business mailing address

6250 W NORTH AVE FL 1
CHICAGO IL
60639-3861
US

V. Phone/Fax

Practice location:
  • Phone: 773-309-8012
  • Fax: 773-622-7440
Mailing address:
  • Phone: 773-309-8012
  • Fax: 773-622-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: