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General NPI Number Information
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NPI Number | 1205441565
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Entity Type | Individual
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Provider Name | TIMOTHY JOSEPH GAITHER LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 5101 WASHINGTON ST STE 2F
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City | GURNEE
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State | IL
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Zip | 60031-2986
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Country | US
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Telephone | 847-367-5991
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Fax | 847-367-5997
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Provider Business Mailing Address
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Address Line | 38036 N PENINSULA RD
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City | LAKE VILLA
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State | IL
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Zip | 60046-9718
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Country | US
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Telephone | 847-987-8149
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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 | 178.016277
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License Number State | IL
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