Healthcare Provider Details

I. General information

NPI: 1831556687
Provider Name (Legal Business Name): KEVIN ALLEN NEWHALL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N NOBLE ST APT 105
CHICAGO IL
60642-7400
US

IV. Provider business mailing address

515 N NOBLE ST APT 105
CHICAGO IL
60642-7400
US

V. Phone/Fax

Practice location:
  • Phone: 773-909-9096
  • Fax:
Mailing address:
  • Phone: 773-909-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.018631
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.015028
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: