Healthcare Provider Details

I. General information

NPI: 1922916261
Provider Name (Legal Business Name): KELCIE BORING ALMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 W DIVERSEY AVE STE 216
CHICAGO IL
60647-7408
US

IV. Provider business mailing address

2400 W WABANSIA AVE APT 508
CHICAGO IL
60647-6824
US

V. Phone/Fax

Practice location:
  • Phone: 253-720-9510
  • Fax:
Mailing address:
  • Phone: 253-720-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208.011702
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: