Healthcare Provider Details
I. General information
NPI: 1750195277
Provider Name (Legal Business Name): AMANDA MICHELLE KUNA PAVELA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1701 E WOODFIELD RD STE 330
SCHAUMBURG IL
60173-5128
US
IV. Provider business mailing address
200 E CHICAGO AVE STE 20
WESTMONT IL
60559-1756
US
V. Phone/Fax
- Phone: 847-592-5588
- Fax:
- Phone: 630-481-4101
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 178.021139 |
| License Number State | IL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YS0200X |
| Taxonomy | School Counselor |
| License Number | 1858465 |
| License Number State | IL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: