Provider Demographics
NPI:1861720914
Name:DEZULSKIS, GREGORY JOHN (LCPC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOHN
Last Name:DEZULSKIS
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 1:1340 S DAMEN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1170
Mailing Address - Country:US
Mailing Address - Phone:312-738-5955
Mailing Address - Fax:312-666-6978
Practice Address - Street 1:1340 S DAMEN AVE STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1170
Practice Address - Country:US
Practice Address - Phone:312-738-5955
Practice Address - Fax:312-666-6978
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000725101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional