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General NPI Number Information
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NPI Number | 1356808083
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Entity Type | Individual
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Provider Name | KATHY MCCALL
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Gender | Female
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 935 W CHESTNUT ST STE 204
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City | CHICAGO
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State | IL
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Zip | 60642-5445
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Country | US
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Telephone | 630-341-0057
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Fax |
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Provider Business Mailing Address
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Address Line | 1133 E 83RD ST UNIT 137
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City | CHICAGO
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State | IL
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Zip | 60619-6448
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Country | US
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Telephone | 630-341-0057
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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 | 180012040
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 32260
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License Number State | IL
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