Healthcare Provider Details

I. General information

NPI: 1669869095
Provider Name (Legal Business Name): KRISTINA MURUKURTHY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E LAKE AVE STE 455
GLENVIEW IL
60025-5535
US

IV. Provider business mailing address

1717 INDEPENDENCE AVE
GLENVIEW IL
60026-7721
US

V. Phone/Fax

Practice location:
  • Phone: 309-360-0913
  • Fax:
Mailing address:
  • Phone: 309-360-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015438
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: