Provider Demographics
NPI:1083755433
Name:GUEBERT, DALE ALAN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:ALAN
Last Name:GUEBERT
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 44 ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7187
Mailing Address - Country:US
Mailing Address - Phone:309-793-3460
Mailing Address - Fax:309-732-0551
Practice Address - Street 1:4709 44 ST
Practice Address - Street 2:SUITE #5
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7187
Practice Address - Country:US
Practice Address - Phone:309-793-3460
Practice Address - Fax:309-732-0551
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor