Provider Demographics
NPI:1679021190
Name:GOSTELE, TAYLOR (LCPC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GOSTELE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:PARDUHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1165 RUSSELLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6859
Mailing Address - Country:US
Mailing Address - Phone:847-744-0415
Mailing Address - Fax:
Practice Address - Street 1:1165 RUSSELLWOOD CT
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6859
Practice Address - Country:US
Practice Address - Phone:847-744-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL180014763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program