Healthcare Provider Details

I. General information

NPI: 1609324607
Provider Name (Legal Business Name): DARREN J KOHLBERG LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N DEARBORN ST STE 400
CHICAGO IL
60654
US

IV. Provider business mailing address

650 N DEARBORN ST STE 400
CHICAGO IL
60654-5358
US

V. Phone/Fax

Practice location:
  • Phone: 773-980-9037
  • Fax:
Mailing address:
  • Phone: 773-980-9037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.010535
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180.010535
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.010535
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.010535
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: