Veronica Gulezian, LCPC, CADC
Individual provider Active NPI Professional Counselor · River Grove, IL
NPI 1497100770 · NPPES record last updated Sep 27, 2019
Key facts
- NPI
- 1497100770
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180012125 (IL)
- Practice address
- 8707 Fullerton Ave
River Grove, IL 60171-1831 - Phone
- (708) 402-8221
- NPI assigned
- Apr 25, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180012125 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Shore Wellness Services, LTD. | Counselor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180012125 | IL | Yes |
Addresses
Primary practice location
8707 Fullerton Ave
River Grove, IL 60171-1831
Mailing address
8707 Fullerton Ave
River Grove, IL 60171-1831
Other practice location 1
425 Huehl Rd
#19b
Northbrook, IL 60062-2319
Phone (847) 205-0371
Other providers in River Grove, IL
- Izabela S Fratczak
- Free Your Speech
- David French
- Matthew L Garstki
- Daniel Goggin
- Elzbieta Gurgul
- Davina Harris
- Head First Health, LLC
- Kevin Hendrix
- Andrea Evelyn Hinojosa
All providers in River Grove, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.