Provider Demographics
NPI:1033644851
Name:MCCLOUD, GELANA L (LCPC)
Entity Type:Individual
Prefix:
First Name:GELANA
Middle Name:L
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:GK ENTERPRISE LLC
Other - Middle Name:DBA LIFELINE COUNSEL
Other - Last Name:CONSULTING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:333 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3268
Mailing Address - Country:US
Mailing Address - Phone:309-407-7771
Mailing Address - Fax:309-620-8623
Practice Address - Street 1:333 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3268
Practice Address - Country:US
Practice Address - Phone:309-407-7771
Practice Address - Fax:309-620-8623
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-30
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health