Healthcare Provider Details

I. General information

NPI: 1003762071
Provider Name (Legal Business Name): YOSAFE GHOLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16335 HARLEM AVE
TINLEY PARK IL
60477-2574
US

IV. Provider business mailing address

16335 HARLEM AVE
TINLEY PARK IL
60477-2574
US

V. Phone/Fax

Practice location:
  • Phone: 708-575-3224
  • Fax:
Mailing address:
  • Phone: 708-575-3224
  • 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: