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General NPI Number Information
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NPI Number | 1962397984
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Entity Type | Individual
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Provider Name | GABRIELA KOCH DA COSTA AGUIAR ALVES
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Gender | Female
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 7621 ROOSEVELT RD
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City | FOREST PARK
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State | IL
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Zip | 60130-2212
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Country | US
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Telephone | 773-234-0423
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Fax |
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Provider Business Mailing Address
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Address Line | 2125 RIDGE AVE APT 2C
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City | EVANSTON
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State | IL
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Zip | 60201-2764
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Country | US
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Telephone | 929-215-2352
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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