Healthcare Provider Details

I. General information

NPI: 1558124172
Provider Name (Legal Business Name): KYLE DAVID BRANNER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2948 ARTESIAN RD STE 112
NAPERVILLE IL
60564-8559
US

IV. Provider business mailing address

13825 S AUTUMN WAY UNIT 203
PLAINFIELD IL
60544-8822
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180017509
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: