Individual provider Active NPI

Reynald Paul Gallosa

  • Professional Counselor
  • McHenry, IL
National Provider Identifier
1740744200
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
180.016732 Issued in IL
Practice address
4031 W Dayton St
McHenry, IL 60050-8377
Phone
(816) 344-1230
NPI assigned
Jan 29, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Professional Counselor 101YP2500X 180.016732 IL Primary

Addresses

Primary practice location

4031 W Dayton St
McHenry, IL 60050-8377

Mailing address

4031 W Dayton St
McHenry, IL 60050-8377
Phone (816) 344-1230

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240813002020 IL Practitioner - Mental Health Counselor 2567900277 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

111 Lions Dr
Suite 210
Barrington, IL 60010-3175
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
180.016732ILMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. CurrentSince Aug 15, 2025 Accepting new patients
Braden Counseling Center, P.C. Professional CurrentSince Apr 25, 2024 Accepting new patients
Psychology Specialists LTD Past Accepting new patients

Locations

111 Lions Dr
Ste 210
Barrington, IL 60010
Phone (847) 304-0044

581 Elm Pl
Ste 110
Highland Park, IL 60035
Phone (847) 861-7771

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

2600 DeKalb Ave
Ste J
Sycamore, IL 60178
Phone (815) 787-9000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1740744200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4031 W DAYTON ST",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508377",
            "telephone_number": "816-344-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4031 W DAYTON ST",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508377",
            "telephone_number": "816-344-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLOSA",
        "first_name": "REYNALD",
        "middle_name": "PAUL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-29",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.016732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.