| Gulf Coast Psych Therapy Group | |
|
828 Davis St Ste 213 Evanston IL 60201-4420 | |
| (312) 781-2850 | |
| (847) 972-6445 |
| Full Name | Gulf Coast Psych Therapy Group |
|---|---|
| Speciality | Psychologist |
| Location | 828 Davis St Ste 213, Evanston, Illinois |
| Authorized Official Name and Position | Terry Dornak (OWNER) |
| Authorized Official Contact | 3127812850 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Psych Therapy Group 828 Davis St Ste 213 Evanston IL 60201-4420 Ph: (312) 781-2850 | Gulf Coast Psych Therapy Group 828 Davis St Ste 213 Evanston IL 60201-4420 Ph: (312) 781-2850 |
| NPI Number | 1184165383 |
|---|---|
| Provider Enumeration Date | 03/20/2017 |
| Last Update Date | 05/15/2023 |
| Certification Date | 05/15/2023 |
| Medicare PECOS PAC ID | 9537423959 |
|---|---|
| Medicare Enrollment ID | O20210927001850 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184165383 | NPI | - | NPPES |
| Provider Name | Elizabeth M Carroll Attella |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205492261 PECOS PAC ID: 2062747488 Enrollment ID: I20190708002103 |
| Provider Name | Terry Ann Dornak |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902286974 PECOS PAC ID: 5890091680 Enrollment ID: I20210927002072 |
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