Provider Demographics
NPI:1649621376
Name:DUPAGE CLINICAL COUNSELING SERVICES
Entity type:Organization
Organization Name:DUPAGE CLINICAL COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEHLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-965-1359
Mailing Address - Street 1:214 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-965-1359
Mailing Address - Fax:
Practice Address - Street 1:450 E 22ND ST
Practice Address - Street 2:SUITE 150
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6113
Practice Address - Country:US
Practice Address - Phone:630-965-1359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty