Provider Demographics
NPI:1982906319
Name:GURGONE, JULIE TEPKE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:TEPKE
Last Name:GURGONE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 N OAKLEY BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3507
Mailing Address - Country:US
Mailing Address - Phone:312-770-2603
Mailing Address - Fax:
Practice Address - Street 1:1127 N. OAKLEY BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:312-770-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006284101YP2500X
IL180008670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180008670OtherILLINOIS STATE LICENASE LCPC