Provider Demographics
NPI:1871624619
Name:GURNEE COUNSELING CENTER
Entity type:Organization
Organization Name:GURNEE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIRSCHBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-336-5621
Mailing Address - Street 1:4212 OLD GRAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2708
Mailing Address - Country:US
Mailing Address - Phone:847-336-5621
Mailing Address - Fax:847-366-2594
Practice Address - Street 1:4212 OLD GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2708
Practice Address - Country:US
Practice Address - Phone:847-336-5621
Practice Address - Fax:847-366-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty