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NPI Code Detail

MEDICARE: ABBEY STOREY GATELY CRC, LCPC

MEDICARE: ABBEY STOREY GATELY CRC, 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 Counselor178.013075IL
2225C00000XRehabilitation Counselor00229815
3101YP2500XProfessional Counselor180.015917IL

General Provider Information

NPI Number : 1619487956
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABBEY STOREY GATELY CRC, LCPC
Provider Business Mailing Address
First Line : 2921 N HALSTED ST APT 3F
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5178
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2755 N PINE GROVE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6109
Country : US
Telephone Number : 312-259-2665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2017
Last Update Date : 03/20/2024

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