| Gaines Psychotherapy, Pllc | |
|
1021 Dodge Ave Apt D Evanston IL 60202-1051 | |
| (816) 419-1189 | |
| Not Available |
| Full Name | Gaines Psychotherapy, Pllc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1021 Dodge Ave Apt D, Evanston, Illinois |
| Authorized Official Name and Position | Ariel Kirch Gaines (OWNER) |
| Authorized Official Contact | 8164191189 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaines Psychotherapy, Pllc 1021 Dodge Ave Apt D Evanston IL 60202-1051 Ph: (816) 419-1189 | Gaines Psychotherapy, Pllc 1021 Dodge Ave Apt D Evanston IL 60202-1051 Ph: (816) 419-1189 |
| NPI Number | 1679292551 |
|---|---|
| Provider Enumeration Date | 08/24/2022 |
| Last Update Date | 02/07/2024 |
| Certification Date | 02/07/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679292551 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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