Healthcare Provider Details

I. General information

NPI: 1245787506
Provider Name (Legal Business Name): CAROLINE KELLY TYE LCPC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 W MONTROSE AVE
CHICAGO IL
60613-1214
US

IV. Provider business mailing address

6528 N GREENVIEW AVE APT 1
CHICAGO IL
60626-5008
US

V. Phone/Fax

Practice location:
  • Phone: 847-651-8643
  • Fax:
Mailing address:
  • Phone: 847-651-8643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180011239
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178012176
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number16-069
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: