Healthcare Provider Details

I. General information

NPI: 1376406025
Provider Name (Legal Business Name): KAITLIN DARBI MASTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4846 N CLARK ST STE 100
CHICAGO IL
60640-7925
US

IV. Provider business mailing address

4457 N MAPLEWOOD AVE APT 1
CHICAGO IL
60625-9244
US

V. Phone/Fax

Practice location:
  • Phone: 312-574-0750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.022499
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: