Provider Demographics
NPI:1316219413
Name:GILBERT, JEFFREY W (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:W
Last Name:GILBERT
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6643 N NEWGARD AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4743
Mailing Address - Country:US
Mailing Address - Phone:773-338-7740
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 1920
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3618
Practice Address - Country:US
Practice Address - Phone:773-338-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2177828556101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health