Healthcare Provider Details

I. General information

NPI: 1174995534
Provider Name (Legal Business Name): KATHARINE KHARAS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N. MICHIGAN AVE SUITE 1212
CHICAGO IL
60602
US

IV. Provider business mailing address

30 N. MICHIGAN AVE SUITE 1212
CHICAGO IL
60602
US

V. Phone/Fax

Practice location:
  • Phone: 773-330-5688
  • Fax:
Mailing address:
  • Phone: 773-330-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: