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General NPI Number Information
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NPI Number | 1932567294
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Entity Type | Individual
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Provider Name | GARY ANTHONY DELEONARDIS JR. LCPC
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Gender | Male
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 5751 W HENDERSON ST
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City | CHICAGO
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State | IL
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Zip | 60634-4331
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Country | US
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Telephone | 312-560-7485
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Fax |
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Provider Business Mailing Address
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Address Line | 5751 W HENDERSON ST
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City | CHICAGO
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State | IL
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Zip | 60634-4331
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Country | US
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Telephone | 312-560-7485
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180009944
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180009944
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180009944
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License Number State | IL
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