Provider Demographics
NPI:1366062655
Name:GUT, JOYCE A
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:GUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W HIAWATHA TRL
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3763
Mailing Address - Country:US
Mailing Address - Phone:224-567-3468
Mailing Address - Fax:
Practice Address - Street 1:201 W HIAWATHA TRL
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3763
Practice Address - Country:US
Practice Address - Phone:224-567-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015362101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health