Provider Demographics
NPI:1720432552
Name:CAMILLE MAYHALL GEHRENBECK, MS, CRC, LCPC, LTD
Entity type:Organization
Organization Name:CAMILLE MAYHALL GEHRENBECK, MS, CRC, LCPC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:MAYHALL
Authorized Official - Last Name:GEHRENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-450-3162
Mailing Address - Street 1:4852 N HOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1408
Mailing Address - Country:US
Mailing Address - Phone:773-450-3162
Mailing Address - Fax:312-284-8865
Practice Address - Street 1:4852 N HOYNE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1408
Practice Address - Country:US
Practice Address - Phone:773-450-3162
Practice Address - Fax:312-284-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060011681252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency