Provider Demographics
NPI:1669763017
Name:GATES OF HOPE PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GATES OF HOPE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:708-837-4673
Mailing Address - Street 1:500 PARK AVENUE
Mailing Address - Street 2:UNIT #631
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5034
Mailing Address - Country:US
Mailing Address - Phone:708-837-4673
Mailing Address - Fax:
Practice Address - Street 1:1525 EAST 53RD STREET
Practice Address - Street 2:SUITE #503
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:708-837-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty