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General NPI Number Information
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NPI Number | 1649621376
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Entity Type | Organization
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Legal Business Name | DUPAGE CLINICAL COUNSELING SERVICES
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 450 E 22ND ST SUITE 150
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City | LOMBARD
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State | IL
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Zip | 60148-6113
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Country | US
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Telephone | 630-965-1359
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Fax |
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Provider Business Mailing Address
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Address Line | 214 WINDSOR DR
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City | BOLINGBROOK
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State | IL
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Zip | 60440
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Country | US
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Telephone | 630-965-1359
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Fax |
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Authorized Official
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Title or Position | THERAPIST/ OWNER
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Name | CARLA GEHLE
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Credential | LCPC
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Telephone | 630-965-1359
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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 | 180010152
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License Number State | IL
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