Healthcare Provider Details

I. General information

NPI: 1922314848
Provider Name (Legal Business Name): KIMBERLY ANN MCCUE PHD, PMH-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KIMBERLY ANN LANHAM

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 FORBS AVE STE 107
HOFFMAN ESTATES IL
60192-3731
US

IV. Provider business mailing address

2815 FORBS AVE STE 107
HOFFMAN ESTATES IL
60192-3731
US

V. Phone/Fax

Practice location:
  • Phone: 847-986-8010
  • Fax: 847-986-8106
Mailing address:
  • Phone: 847-986-8010
  • Fax: 847-986-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: