Organization
RUFUS GONZALES PSYCHOTHERPAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUFUS R GONZALES PHD (OWNER)
(708) 512-4854
Entity
Organization
Contact information
Practice address
6238 N CLARK ST, CHICAGO, IL 60660-1202
(708) 512-4854
Mailing address
6238 N CLARK ST, CHICAGO, IL 60660-1202
(708) 512-4854
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
071007450
IL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
071007450
IL
Other
Enumeration date
12/12/2017
Last updated
12/12/2017
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