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General NPI Number Information
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NPI Number | 1992587422
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Entity Type | Individual
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Provider Name | IVAN GOMEZ LPC, NCC
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Gender | Male
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Dates
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Enumeration Date | 10/18/2023
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 31 W DOWNER PL STE 307308
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City | AURORA
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State | IL
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Zip | 60506-5123
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Country | US
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Telephone | 630-733-9108
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Fax |
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Provider Business Mailing Address
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Address Line | 1013 LEGRANDE AVE
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City | AURORA
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State | IL
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Zip | 60506-6381
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Country | US
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Telephone | 630-765-4147
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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 | 178018438
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License Number State | IL
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