Provider Demographics
NPI:1285844910
Name:JOHN GOLL COUNSELING, LTD
Entity Type:Organization
Organization Name:JOHN GOLL COUNSELING, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:317-289-0982
Mailing Address - Street 1:530 WING LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2340
Mailing Address - Country:US
Mailing Address - Phone:317-289-0982
Mailing Address - Fax:
Practice Address - Street 1:2100 MANCHESTER RD STE 400-A
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4579
Practice Address - Country:US
Practice Address - Phone:630-909-9605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty