Provider Demographics
NPI:1962928192
Name:GERENA, GRISEL (LPC)
Entity type:Individual
Prefix:
First Name:GRISEL
Middle Name:
Last Name:GERENA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9904 W MICHIGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60099-3854
Mailing Address - Country:US
Mailing Address - Phone:224-730-3352
Mailing Address - Fax:
Practice Address - Street 1:49 SHERWOOD TER STE R
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2231
Practice Address - Country:US
Practice Address - Phone:847-582-0588
Practice Address - Fax:847-278-8559
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health