Provider Demographics
NPI:1245700517
Name:GOMEZ SCOTT, PAMELA JUNE (LCPC, CADC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JUNE
Last Name:GOMEZ SCOTT
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N DEARBORN ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4322
Mailing Address - Country:US
Mailing Address - Phone:312-986-4119
Mailing Address - Fax:312-986-4187
Practice Address - Street 1:1 N DEARBORN ST STE 1000
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4322
Practice Address - Country:US
Practice Address - Phone:312-986-4119
Practice Address - Fax:312-986-4187
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006513101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional