Provider Demographics
NPI:1174795652
Name:MARY C. GURNEY, PC
Entity type:Organization
Organization Name:MARY C. GURNEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-398-2877
Mailing Address - Street 1:1639 N ALPINE RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1449
Mailing Address - Country:US
Mailing Address - Phone:815-398-2877
Mailing Address - Fax:
Practice Address - Street 1:1639 N ALPINE RD
Practice Address - Street 2:SUITE 403
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1449
Practice Address - Country:US
Practice Address - Phone:815-398-2877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty