Healthcare Provider Details

I. General information

NPI: 1710143706
Provider Name (Legal Business Name): KIMBERLY KAY PEYTON REYES LCPC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MARION ST
OAK PARK IL
60302-2809
US

IV. Provider business mailing address

9649 W 55TH ST
COUNTRYSIDE IL
60525-3699
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-7500
  • Fax:
Mailing address:
  • Phone: 708-352-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.014759
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: