Provider Demographics
NPI:1992754261
Name:GILL, THOMAS EDWARD (MA LCPC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:GILL
Suffix:
Gender:M
Credentials:MA LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W ROOSEVELT RD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5086
Mailing Address - Country:US
Mailing Address - Phone:630-462-1999
Mailing Address - Fax:630-462-0069
Practice Address - Street 1:620 W ROOSEVELT RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5086
Practice Address - Country:US
Practice Address - Phone:630-462-1999
Practice Address - Fax:630-462-0069
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2208034OtherBCBSIL