Healthcare Provider Details

I. General information

NPI: 1285161752
Provider Name (Legal Business Name): KAWAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 RIDGE AVE STE 101
EVANSTON IL
60201-5908
US

IV. Provider business mailing address

1740 RIDGE AVE STE 101
EVANSTON IL
60201-5908
US

V. Phone/Fax

Practice location:
  • Phone: 847-334-0857
  • Fax: 847-334-0857
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MAYA SHEWNARAIN
Title or Position: THERAPIST
Credential:
Phone: 847-334-0857