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General NPI Number Information
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NPI Number | 1114576089
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Entity Type | Individual
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Provider Name | KEVIN M VAIL LCPC
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Gender | Male
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 2835 N SHEFFIELD AVE STE 223
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City | CHICAGO
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State | IL
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Zip | 60657-5083
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Country | US
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Telephone | 773-236-1838
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Fax |
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Provider Business Mailing Address
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Address Line | 2835 N SHEFFIELD AVE STE 223
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City | CHICAGO
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State | IL
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Zip | 60657-5083
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Country | US
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Telephone | 773-236-1838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178015143
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180014297
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License Number State | IL
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