Provider Demographics
NPI:1295086734
Name:CARREON, GERALD L (LMFT)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:CARREON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WEST JACKSON STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455
Mailing Address - Country:US
Mailing Address - Phone:309-575-3222
Mailing Address - Fax:309-404-8000
Practice Address - Street 1:1601 WEST JACKSON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455
Practice Address - Country:US
Practice Address - Phone:309-575-3222
Practice Address - Fax:309-404-8000
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166 000856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist