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General NPI Number Information
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NPI Number | 1205468410
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Entity Type | Organization
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Legal Business Name | KIVA PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 636 CHURCH ST STE 507
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City | EVANSTON
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State | IL
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Zip | 60201-4581
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Country | US
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Telephone | 847-686-1803
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Fax |
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Provider Business Mailing Address
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Address Line | 636 CHURCH ST STE 507
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City | EVANSTON
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State | IL
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Zip | 60201-4581
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Country | US
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Telephone | 847-686-1803
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | BROOKE HALPERN
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Credential | PSYD
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Telephone | 847-686-1803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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