Provider Demographics
NPI:1134144470
Name:GROSS, ELEANOR J (LCPC)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:J
Last Name:GROSS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N RIVERSIDE DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5918
Mailing Address - Country:US
Mailing Address - Phone:847-263-1269
Mailing Address - Fax:847-263-1310
Practice Address - Street 1:501 N RIVERSIDE DR
Practice Address - Street 2:SUITE 208
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5918
Practice Address - Country:US
Practice Address - Phone:847-263-1269
Practice Address - Fax:847-263-1310
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional