Provider Demographics
NPI:1437740099
Name:GALLANT, TANIA MARGO (LPC)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:MARGO
Last Name:GALLANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:TATIANA
Other - Middle Name:MARGO
Other - Last Name:GALLANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:120 HASTINGS CT
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-4001
Mailing Address - Country:US
Mailing Address - Phone:224-523-3723
Mailing Address - Fax:
Practice Address - Street 1:120 HASTINGS CT
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-4001
Practice Address - Country:US
Practice Address - Phone:224-523-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178015488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203697804OtherBUSINESS ID