Healthcare Provider Details

I. General information

NPI: 1861823064
Provider Name (Legal Business Name): DAVID KOHLER PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 W BELMONT AVE 1
CHICAGO IL
60618-7879
US

IV. Provider business mailing address

2153 W BELMONT AVE UNIT 1
CHICAGO IL
60618-7879
US

V. Phone/Fax

Practice location:
  • Phone: 773-573-9117
  • Fax:
Mailing address:
  • Phone: 773-573-9117
  • Fax: 844-649-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number071008692
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071008692
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008692
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number071008692
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number071008692
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number071008692
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: