Healthcare Provider Details

I. General information

NPI: 1871119552
Provider Name (Legal Business Name): GABRIELLE PELHAM LPC ATR-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E DIEHL RD STE 110
NAPERVILLE IL
60563-4808
US

IV. Provider business mailing address

900 E DIEHL RD STE 110
NAPERVILLE IL
60563-4808
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone: 630-428-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.014859
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number19-564
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: