Healthcare Provider Details

I. General information

NPI: 1578282679
Provider Name (Legal Business Name): GABRIELLE C. GEBEL PHD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 W GRAND AVE STE B PMB 815600
CHICAGO IL
60612-1577
US

IV. Provider business mailing address

2045 W GRAND AVE STE B PMB 815600
CHICAGO IL
60612-1577
US

V. Phone/Fax

Practice location:
  • Phone: 312-788-7014
  • Fax:
Mailing address:
  • Phone: 312-788-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number166.001611
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number002002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: