Healthcare Provider Details

I. General information

NPI: 1891519559
Provider Name (Legal Business Name): KRISTINE PUENTE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S HIGHLAND AVE STE 325A
LOMBARD IL
60148-6181
US

IV. Provider business mailing address

8643 ROCKEFELLER AVE
BROOKFIELD IL
60513-1414
US

V. Phone/Fax

Practice location:
  • Phone: 630-613-8176
  • Fax:
Mailing address:
  • Phone: 708-703-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.019626
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: