Provider Demographics
NPI:1548598196
Name:GEHRENBECK, CAMILLE MAYHALL (CRC, LCPC)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:MAYHALL
Last Name:GEHRENBECK
Suffix:
Gender:F
Credentials:CRC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4852 N HOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1408
Mailing Address - Country:US
Mailing Address - Phone:773-450-3162
Mailing Address - Fax:773-681-7374
Practice Address - Street 1:4852 N HOYNE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1408
Practice Address - Country:US
Practice Address - Phone:773-450-3162
Practice Address - Fax:773-681-7374
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional