Healthcare Provider Details

I. General information

NPI: 1699693911
Provider Name (Legal Business Name): KALI KOLLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

330 W TERRA COTTA AVE STE A
CRYSTAL LAKE IL
60014-3552
US

IV. Provider business mailing address

1159 CENTRAL PARK DR UNIT 204
CRYSTAL LAKE IL
60014-8222
US

V. Phone/Fax

Practice location:
  • Phone: 815-382-9691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: