Healthcare Provider Details

I. General information

NPI: 1326677808
Provider Name (Legal Business Name): KINSHIP COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 N WINTHROP AVE APT 3
CHICAGO IL
60660-4355
US

IV. Provider business mailing address

5700 N WINTHROP AVE APT 3
CHICAGO IL
60660-4355
US

V. Phone/Fax

Practice location:
  • Phone: 573-745-1196
  • Fax:
Mailing address:
  • Phone: 573-745-1196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA A GREGORY
Title or Position: OWNER
Credential:
Phone: 573-745-1196