Provider Demographics
NPI:1841359957
Name:SWEET, GORDON V (LCPC)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:V
Last Name:SWEET
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 1:1502 W PRATT BLVD
Mailing Address - Street 2:#1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4219
Mailing Address - Country:US
Mailing Address - Phone:773-508-5313
Mailing Address - Fax:
Practice Address - Street 1:8020 W 87TH ST
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1189
Practice Address - Country:US
Practice Address - Phone:708-741-4500
Practice Address - Fax:708-741-4501
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
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