Healthcare Provider Details

I. General information

NPI: 1558200154
Provider Name (Legal Business Name): K AND K COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E GRANVILLE AVE
ROSELLE IL
60172-1434
US

IV. Provider business mailing address

130 E GRANVILLE AVE
ROSELLE IL
60172-1434
US

V. Phone/Fax

Practice location:
  • Phone: 224-257-1204
  • Fax:
Mailing address:
  • Phone: 224-257-1204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SHANNON DURIS
Title or Position: CO-OWNER
Credential: LCPC
Phone: 224-257-1204