Organization
IDEAL SELF, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLIE GAYNOR LCPC, CH (PRESIDENT)
(847) 468-1311
Entity
Organization
Contact information
Practice address
5150 LANDERS RD, HOFFMAN ESTATES, IL 60192-4500
(847) 468-1311
Mailing address
5150 LANDERS RD, HOFFMAN ESTATES, IL 60192-4500
(847) 468-1311
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
IL
Other
Enumeration date
07/22/2007
Last updated
07/22/2007
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