Healthcare Provider Details

I. General information

NPI: 1982127668
Provider Name (Legal Business Name): GAIL REICH PSYCHOTHERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 N LINCOLN AVE STE I
CHICAGO IL
60618-1807
US

IV. Provider business mailing address

833 W BUENA AVE APT 806
CHICAGO IL
60613-6606
US

V. Phone/Fax

Practice location:
  • Phone: 773-451-5874
  • Fax:
Mailing address:
  • Phone: 201-919-2469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number180.010240
License Number StateIL

VIII. Authorized Official

Name: GAIL REICH
Title or Position: OWNER
Credential: LCPC
Phone: 773-451-5874