Healthcare Provider Details

I. General information

NPI: 1124842315
Provider Name (Legal Business Name): KARSYN PRESCOTT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N YORK ST STE 202
ELMHURST IL
60126-2827
US

IV. Provider business mailing address

2311 N GREENVIEW AVE # 1R
CHICAGO IL
60614-8718
US

V. Phone/Fax

Practice location:
  • Phone: 630-244-5299
  • Fax:
Mailing address:
  • Phone: 645-221-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: