Healthcare Provider Details

I. General information

NPI: 1073840740
Provider Name (Legal Business Name): KGH CONSULTATION & TREATMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 03/09/2022
Certification Date: 12/30/2021
Deactivation Date: 04/23/2020
Reactivation Date: 05/11/2020

III. Provider practice location address

1161 LAKE COOK RD
DEERFIELD IL
60015-5649
US

IV. Provider business mailing address

1161 LAKE COOK RD
DEERFIELD IL
60015-5649
US

V. Phone/Fax

Practice location:
  • Phone: 847-498-5437
  • Fax: 847-498-5438
Mailing address:
  • Phone: 847-498-5437
  • Fax: 847-498-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number612826
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY GARVEY HOEHNE
Title or Position: CEO
Credential: MA,BCBA
Phone: 847-498-5437