Organization
GATEWAY PROFESSIONAL SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATINA RUSSELL (CREDENTIALING SPECIALIST)
(312) 663-1130
Entity
Organization
Contact information
Practice address
4812 N SHERIDAN RD, PEORIA, IL 61614-5969
(877) 381-6538
Mailing address
55 E JACKSON BLVD STE 1500, CHICAGO, IL 60604-4184
(312) 663-1130
(312) 663-0504
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
04/30/2024
Last updated
06/14/2024
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