Provider Demographics
NPI:1235356957
Name:KENNETH GATES AND ASSOCIATES
Entity Type:Organization
Organization Name:KENNETH GATES AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-444-9210
Mailing Address - Street 1:8600 US HIGHWAY 14
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2706
Mailing Address - Country:US
Mailing Address - Phone:815-444-9210
Mailing Address - Fax:815-444-0783
Practice Address - Street 1:8600 US HIGHWAY 14
Practice Address - Street 2:SUITE 110
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-2706
Practice Address - Country:US
Practice Address - Phone:815-444-9210
Practice Address - Fax:815-444-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty