Healthcare Provider Details

I. General information

NPI: 1982907440
Provider Name (Legal Business Name): KAREN ELIZABETH FOCHT LMFT, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 N CLARK ST. SUITE 411
CHICAGO IL
60610-7473
US

IV. Provider business mailing address

226 W SAINT PAUL AVE #2
CHICAGO IL
60614-8911
US

V. Phone/Fax

Practice location:
  • Phone: 312-533-0248
  • Fax: 312-803-2128
Mailing address:
  • Phone: 312-533-0248
  • Fax: 312-280-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166.000812
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: