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General NPI Number Information
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NPI Number | 1285844910
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Entity Type | Organization
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Legal Business Name | JOHN GOLL COUNSELING, LTD
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 2100 MANCHESTER RD STE 400-A
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City | WHEATON
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State | IL
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Zip | 60187-4579
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Country | US
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Telephone | 630-909-9605
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Fax |
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Provider Business Mailing Address
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Address Line | 530 WING LN
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City | ST CHARLES
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State | IL
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Zip | 60174-2340
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Country | US
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Telephone | 317-289-0982
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN GOLL
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Credential | L.M.F.T.
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Telephone | 317-289-0982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.001069
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License Number State | IL
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