Provider Demographics
NPI:1831300474
Name:GURTZ, GABRIELLE (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:GURTZ
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 ROSE CT E
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3256
Mailing Address - Country:US
Mailing Address - Phone:847-502-1240
Mailing Address - Fax:
Practice Address - Street 1:1327 ROSE CT E
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3256
Practice Address - Country:US
Practice Address - Phone:847-502-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009623101YP2500X
IL180.009623101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health