Provider Demographics
NPI:1588786636
Name:GILHAM, NATHANIEL L (LCPC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:L
Last Name:GILHAM
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E 162ND ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2471
Mailing Address - Country:US
Mailing Address - Phone:708-225-1237
Mailing Address - Fax:708-225-1338
Practice Address - Street 1:900 E 162ND ST
Practice Address - Street 2:SUITE 207
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2471
Practice Address - Country:US
Practice Address - Phone:708-225-1237
Practice Address - Fax:708-225-1338
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional