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General NPI Number Information
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NPI Number | 1114667813
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Entity Type | Individual
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Provider Name | KIMBERLEE A JOHANNESEN
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Gender | Female
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 20 N CLARK ST STE 2750
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City | CHICAGO
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State | IL
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Zip | 60602-5103
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Country | US
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Telephone | 866-296-5262
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Fax | 877-991-8819
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Provider Business Mailing Address
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Address Line | 8906 CARDWELL LN
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City | HOUSTON
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State | TX
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Zip | 77055-4732
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Country | US
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Telephone | 713-416-1921
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.001177
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License Number State | IL
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