MEDICARE: MR. CHRIS E GONZALES MS, NCC, LPC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	IL
2	101YP2500X	Professional Counselor	IL
3	101Y00000X	Counselor	IL
4	101YM0800X	Mental Health Counselor	IL

General Provider Information

NPI Number	:	1699260653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRIS E GONZALES MS, NCC, LPC

Provider Business Mailing Address
First Line	:	1484 CAMBRIA DR UNIT 4
Second Line	:
City	:	DEKALB
State	:	IL
Zip	:	60115-1084
Country	:	US
Telephone Number	:	630-267-2728
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 S. LINCOLNWAY
Second Line	:	F
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1663
Country	:	US
Telephone Number	:	630-267-2728
Fax Number	:	630-801-1675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	06/22/2018

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