Provider Demographics
NPI:1508992892
Name:MORIN, GREGORY R (LCPC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:MORIN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5839
Mailing Address - Country:US
Mailing Address - Phone:815-741-1435
Mailing Address - Fax:
Practice Address - Street 1:2112 W JEFFERSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6663
Practice Address - Country:US
Practice Address - Phone:815-744-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional