Healthcare Provider Details

I. General information

NPI: 1730420019
Provider Name (Legal Business Name): CARLA MARIE GEHLE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 22ND ST SUITE 150
LOMBARD IL
60148-6113
US

IV. Provider business mailing address

450 E 22ND ST SUITE 150
LOMBARD IL
60148-6113
US

V. Phone/Fax

Practice location:
  • Phone: 603-965-1359
  • Fax:
Mailing address:
  • Phone: 603-965-1359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.010152
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: