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NPI Code Detail

MEDICARE: QUINCEY F. KYLES COUNSELING SERVICES, LLC.

MEDICARE: QUINCEY F. KYLES COUNSELING SERVICES, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1619589264
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUINCEY F. KYLES COUNSELING SERVICES, LLC.
Provider Business Mailing Address
First Line : 2650 W MONTROSE AVE STE 205
Second Line :
City : CHICAGO
State : IL
Zip : 60618-1674
Country : US
Telephone Number : 404-543-5654
Fax Number : 312-275-7564
Provider Business Practice Location Address
First Line : 2650 W MONTROSE AVE STE 205
Second Line :
City : CHICAGO
State : IL
Zip : 60618-1674
Country : US
Telephone Number : 404-543-5654
Fax Number : 312-275-7564
Authorized Official
Title or Position : MENTAL HEALTH THERAPIST
Name : MR. QUINCEY FITZGERALD KYLES
Credential : LCSW
Telephone Number : 404-543-5654
Provider Enumeration Date : 08/17/2020
Last Update Date : 02/02/2022

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