Provider Demographics
NPI:1699789669
Name:VAN HEEST, GARY NICHOLAS (LCPC/LMHC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:NICHOLAS
Last Name:VAN HEEST
Suffix:
Gender:M
Credentials:LCPC/LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 EXCHANGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60466-2755
Mailing Address - Country:US
Mailing Address - Phone:708-672-6515
Mailing Address - Fax:
Practice Address - Street 1:526 DEER TRAIL RD
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1604
Practice Address - Country:US
Practice Address - Phone:708-755-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
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