Healthcare Provider Details

I. General information

NPI: 1750046108
Provider Name (Legal Business Name): KENABU WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 W INSTITUTE PL STE 500
CHICAGO IL
60610-8792
US

IV. Provider business mailing address

818 E 63RD ST STE 123
CHICAGO IL
60637-3518
US

V. Phone/Fax

Practice location:
  • Phone: 312-612-0264
  • Fax:
Mailing address:
  • Phone: 312-345-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENYA BUTTS
Title or Position: CEO
Credential: LCSW
Phone: 312-612-0264