Doctor Name: | CINDY J GULLO |
NPI Number: | 1750720512 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.P.C |
License Number: | 180008651 |
Business Practice Address: | 1161 Fortune Blvd Suite 400 Shiloh, IL - 622697385 |
Business Phone Number: | 6189787514 |
Business Fax Number: | 6185885274 |
Mailing Address: | 101 S Railway Street, NEW BADEN |
State: | IL |
Postal Code: | 62265 |
Phone Number: | 6189787514 |
Fax Number: | 6185885274 |
NPI Enumeration Date: | 06/14/2013 |
NPI Last Update Date: | 08/13/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180008651 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |