Provider Demographics
NPI:1679292551
Name:GAINES PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:GAINES PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:KIRCH
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:816-419-1189
Mailing Address - Street 1:1021 DODGE AVE APT D
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1051
Mailing Address - Country:US
Mailing Address - Phone:816-419-1189
Mailing Address - Fax:
Practice Address - Street 1:1021 DODGE AVE APT D
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1051
Practice Address - Country:US
Practice Address - Phone:816-419-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty