Provider Demographics
NPI:1699071142
Name:GOMBIS, STEPHAN MATTHEW (LCPC)
Entity type:Individual
Prefix:MR
First Name:STEPHAN
Middle Name:MATTHEW
Last Name:GOMBIS
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 1:221 E CULLERTON ST
Mailing Address - Street 2:UNIT 101A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1386
Mailing Address - Country:US
Mailing Address - Phone:708-528-7025
Mailing Address - Fax:
Practice Address - Street 1:221 E CULLERTON ST
Practice Address - Street 2:UNIT 101A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1386
Practice Address - Country:US
Practice Address - Phone:708-528-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional