Healthcare Provider Details

I. General information

NPI: 1265082523
Provider Name (Legal Business Name): NICHOLAS ANDREW KRYSZTOPIK LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1457 N HALSTED ST UNIT B303
CHICAGO IL
60642-2677
US

IV. Provider business mailing address

10537 S ROBERTS RD
PALOS HILLS IL
60465-1933
US

V. Phone/Fax

Practice location:
  • Phone: 773-977-4737
  • Fax: 708-974-2498
Mailing address:
  • Phone: 708-974-5100
  • Fax: 708-974-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.016826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: