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NPI Code Detail

MEDICARE: GIDEON GREENE LCPC

MEDICARE: GIDEON GREENE LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor180017864IL

General Provider Information

NPI Number : 1588517346
Entity Type Code : Individual
Provider Name (Legal Business Name) : GIDEON GREENE LCPC
Provider Business Mailing Address
First Line : 1748 N KIMBALL AVE STE 206
Second Line :
City : CHICAGO
State : IL
Zip : 60647-4806
Country : US
Telephone Number : 312-899-6707
Fax Number :
Provider Business Practice Location Address
First Line : 1748 N KIMBALL AVE STE 206
Second Line :
City : CHICAGO
State : IL
Zip : 60647-4806
Country : US
Telephone Number : 312-899-6707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2026
Last Update Date : 02/19/2026

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Directions to “ GIDEON GREENE LCPC” Practice Location

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