Provider Demographics
NPI:1992147664
Name:GOSSE, HOLLY (MS, LCPC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GOSSE
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 W LAWRENCE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1948
Mailing Address - Country:US
Mailing Address - Phone:773-850-1650
Mailing Address - Fax:
Practice Address - Street 1:2334 W LAWRENCE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1948
Practice Address - Country:US
Practice Address - Phone:773-850-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor