Healthcare Provider Details

I. General information

NPI: 1801506860
Provider Name (Legal Business Name): TERESA K GEBHARDT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 KATRINA LN
SLEEPY HOLLOW IL
60118-3123
US

IV. Provider business mailing address

47 KATRINA LN
SLEEPY HOLLOW IL
60118-3123
US

V. Phone/Fax

Practice location:
  • Phone: 224-699-0196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178011162
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: