Organization
JACQUES GOURGUECHON, LPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUES A. GOURGUECHON LPC (PRINCIPAL)
(312) 203-9211
Entity
Organization
Contact information
Practice address
1454 W FARRAGUT AVE, CHICAGO, IL 60640-2104
(312) 203-9211
Mailing address
1454 W FARRAGUT AVE, CHICAGO, IL 60640-2104
(312) 203-9211
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
178.010830
IL
Other
Enumeration date
05/15/2015
Last updated
05/15/2015
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