| Gateway Professional Services, Pc | |
|
4812 N Sheridan Rd Peoria IL 61614-5969 | |
| (877) 381-6538 | |
| Not Available |
| Full Name | Gateway Professional Services, Pc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 4812 N Sheridan Rd, Peoria, Illinois |
| Authorized Official Name and Position | Latina Russell (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 3126631130 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Professional Services, Pc 55 E Jackson Blvd Ste 1500 Chicago IL 60604-4184 Ph: (312) 663-1130 | Gateway Professional Services, Pc 4812 N Sheridan Rd Peoria IL 61614-5969 Ph: (877) 381-6538 |
| NPI Number | 1467208389 |
|---|---|
| Provider Enumeration Date | 04/30/2024 |
| Last Update Date | 06/14/2024 |
| Certification Date | 06/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467208389 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
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