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General NPI Number Information
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NPI Number | 1003611005
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Entity Type | Organization
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Legal Business Name | KICKSTAND COUNSELING, PLLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 5120 MAIN ST STE 103
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-4667
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Country | US
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Telephone | 630-640-5268
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Fax |
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Provider Business Mailing Address
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Address Line | 2640 WOODMERE DR
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City | DARIEN
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State | IL
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Zip | 60561-1503
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Country | US
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Telephone | 630-640-5268
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL COUNSELOR
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Name | KARLA BUCK
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Credential | NCC, LCPC, CADC, CGP
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Telephone | 630-640-5268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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