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General NPI Number Information
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NPI Number | 1588739411
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Entity Type | Individual
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Provider Name | GREGORY LEE MAHONEY M.A., L.C.P.C.
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Gender | Male
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 264 LANGTON LN
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1922
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Country | US
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Telephone | 224-289-2054
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Fax |
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Provider Business Mailing Address
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Address Line | 701 WINTHROP AVE
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City | GLENDALE HEIGHTS
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State | IL
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Zip | 60139-1405
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Country | US
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Telephone | 630-545-5159
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180003430
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License Number State | IL
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