Healthcare Provider Details

I. General information

NPI: 1336682210
Provider Name (Legal Business Name): KARISSA HABEL-SMALL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9611 165TH ST SUTITE 16
ORLAND PARK IL
60467-5654
US

IV. Provider business mailing address

9611 165TH ST SUTITE 16
ORLAND PARK IL
60467-5654
US

V. Phone/Fax

Practice location:
  • Phone: 708-949-8688
  • Fax:
Mailing address:
  • Phone: 708-949-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number178010863
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178010863
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: