Provider Demographics
NPI:1215102694
Name:GEHANT-SMITH, PAMELA (LCPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GEHANT-SMITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 WEAVER PARKWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555
Mailing Address - Country:US
Mailing Address - Phone:630-473-3970
Mailing Address - Fax:630-994-5028
Practice Address - Street 1:4580 WEAVER PARKWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555
Practice Address - Country:US
Practice Address - Phone:630-473-3970
Practice Address - Fax:630-994-5028
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional