Provider Demographics
NPI:1790120640
Name:GUMIROV, MAYA (LPC)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:GUMIROV
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 W SHURE DR STE 180
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7803
Mailing Address - Country:US
Mailing Address - Phone:847-392-8820
Mailing Address - Fax:
Practice Address - Street 1:1156 W SHURE DR STE 180
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7803
Practice Address - Country:US
Practice Address - Phone:847-392-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-006992101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional