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General NPI Number Information
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NPI Number | 1063978955
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Entity Type | Individual
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Provider Name | TONI GARY LPC
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Gender | Female
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Dates
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Enumeration Date | 02/15/2019
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 123 N ROSEDALE AVE STE 100
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1039
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Country | US
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Telephone | 630-893-6685
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Fax |
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Provider Business Mailing Address
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Address Line | 7542 ADAMS ST APT 202
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City | FOREST PARK
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State | IL
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Zip | 60130-1748
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.016371
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License Number State | IL
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