Provider Demographics
NPI:1508296559
Name:GOTTRICH COUNSELING AND CONSULTING SERVICES PC
Entity Type:Organization
Organization Name:GOTTRICH COUNSELING AND CONSULTING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOTTRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:217-726-9882
Mailing Address - Street 1:975 S DURKIN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1386
Mailing Address - Country:US
Mailing Address - Phone:217-726-9882
Mailing Address - Fax:217-726-9862
Practice Address - Street 1:975 S DURKIN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1386
Practice Address - Country:US
Practice Address - Phone:217-726-9882
Practice Address - Fax:217-726-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty