Provider Demographics
NPI:1629725809
Name:JAMIE GILMARTIN LICENSED CLINICAL PROFESSIONAL COUNSELOR
Entity Type:Organization
Organization Name:JAMIE GILMARTIN LICENSED CLINICAL PROFESSIONAL COUNSELOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-574-3437
Mailing Address - Street 1:6835 FORESTVIEW DR APT 3D
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1634
Mailing Address - Country:US
Mailing Address - Phone:708-574-3437
Mailing Address - Fax:
Practice Address - Street 1:14810 CICERO AVE STE 1D
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1460
Practice Address - Country:US
Practice Address - Phone:708-574-3437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)