Healthcare Provider Details

I. General information

NPI: 1306913512
Provider Name (Legal Business Name): DAVID LEE GATES M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N RIVERSIDE DR #111
GURNEE IL
60031-5918
US

IV. Provider business mailing address

501 N RIVERSIDE DR #111
GURNEE IL
60031-5918
US

V. Phone/Fax

Practice location:
  • Phone: 847-625-0606
  • Fax:
Mailing address:
  • Phone: 847-625-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: