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General NPI Number Information
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NPI Number | 1902308497
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Entity Type | Organization
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Legal Business Name | GONZALEZ CLINICAL THERAPY LLC
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 1400 E TOUHY AVENUE SUITE 240
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City | DES PLAINES
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State | IL
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Zip | 60018
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Country | US
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Telephone | 630-877-5760
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 E TOUHY AVENUE SUITE 240
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City | DES PLAINES
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State | IL
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Zip | 60018
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Country | US
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Telephone | 630-877-5760
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Fax |
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Authorized Official
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Title or Position | CLINICAL COUNSELOR
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Name | MS. NORA GONZLAEZ
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Credential | LCPC
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Telephone | 630-877-5760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | IL
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