Healthcare Provider Details

I. General information

NPI: 1073440764
Provider Name (Legal Business Name): KEVIN CRYSTAL COUNSELING P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CHURCH ST STE 511
EVANSTON IL
60201-4581
US

IV. Provider business mailing address

636 CHURCH ST STE 511
EVANSTON IL
60201-4581
US

V. Phone/Fax

Practice location:
  • Phone: 773-972-5844
  • Fax:
Mailing address:
  • Phone: 773-972-5844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. KEVIN FREDERICK CRYSTAL
Title or Position: COUNSELOR/ PRESIDENT
Credential: LCPC
Phone: 847-440-4838