Provider Demographics
NPI:1639197858
Name:GULLO, LINDA HNETYNKA (LCPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:HNETYNKA
Last Name:GULLO
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 1:411 E CONGRESS PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6266
Mailing Address - Country:US
Mailing Address - Phone:815-459-5161
Mailing Address - Fax:815-459-5199
Practice Address - Street 1:411 E CONGRESS PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6266
Practice Address - Country:US
Practice Address - Phone:815-459-5161
Practice Address - Fax:815-459-5199
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632076Medicare UPIN