Provider Demographics
NPI:1730420019
Name:GEHLE, CARLA MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:GEHLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E 22ND ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6113
Mailing Address - Country:US
Mailing Address - Phone:603-965-1359
Mailing Address - Fax:
Practice Address - Street 1:450 E 22ND ST
Practice Address - Street 2:SUITE 150
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6113
Practice Address - Country:US
Practice Address - Phone:603-965-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional