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General NPI Number Information
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NPI Number | 1184013930
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Entity Type | Organization
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Legal Business Name | KM INSTITUTE, LLC.
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 1444 N FARNSWORTH AVE STE 304
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City | AURORA
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State | IL
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Zip | 60505-1642
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Country | US
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Telephone | 331-213-9706
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Fax |
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Provider Business Mailing Address
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Address Line | 1444 N FARNSWORTH AVE STE 304
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City | AURORA
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State | IL
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Zip | 60505-1642
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Country | US
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Telephone | 331-213-9706
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KRISTY CAMILLE-MCKINESS
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Credential | ED.D LCPC
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Telephone | 331-213-9706
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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 | 180.007038
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License Number State | IL
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