Provider Demographics
NPI:1295371367
Name:GOL RELATIONAL CENTER, PLLC
Entity Type:Organization
Organization Name:GOL RELATIONAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MS
Authorized Official - First Name:FATEME
Authorized Official - Middle Name:TARGOL
Authorized Official - Last Name:HASANKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-366-4901
Mailing Address - Street 1:4611 N RAVENSWOOD AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4611 N RAVENSWOOD AVE STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7577
Practice Address - Country:US
Practice Address - Phone:773-366-4901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty