Provider Demographics
NPI:1568443943
Name:GOLD, MINDY B (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:B
Last Name:GOLD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E DELAWARE PLACE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-280-2134
Mailing Address - Fax:312-280-8365
Practice Address - Street 1:1 E DELAWARE PLACE
Practice Address - Street 2:SUITE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1449
Practice Address - Country:US
Practice Address - Phone:312-280-2134
Practice Address - Fax:312-280-8365
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6812101YA0400X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional