Provider Demographics
NPI:1336266543
Name:GORTON, DEBORAH ELIZABETH (PHD, LCP)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELIZABETH
Last Name:GORTON
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 N CLARK ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6804
Mailing Address - Country:US
Mailing Address - Phone:312-905-3612
Mailing Address - Fax:
Practice Address - Street 1:858 N CLARK ST STE 203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6804
Practice Address - Country:US
Practice Address - Phone:312-905-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008428103TC0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor