Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003223579 |
---|---|
Provider Name | Katharina Gounaris |
First Address | Woodstock, IL 60098-3437 |
Second Address | Woodstock, IL 60098-3437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2014 |
Last Update Date | 16/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XOH848898161 | BLUECROSS BLUESHIELD, BLUE ADVANTAGE HMO (01) | IL |