Healthcare Provider Details

I. General information

NPI: 1811227598
Provider Name (Legal Business Name): ROBERT GELLMAN MS, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2010
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 S WESTERN AVE SUITE 405
CHICAGO IL
60643-2536
US

IV. Provider business mailing address

10540 S WESTERN AVE SUITE 405
CHICAGO IL
60643-2536
US

V. Phone/Fax

Practice location:
  • Phone: 773-799-1419
  • Fax:
Mailing address:
  • Phone: 773-799-1419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: