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General NPI Number Information
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NPI Number | 1356898647
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Entity Type | Individual
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Provider Name | KEVIN CRYSTAL LCPC
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Gender | Male
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Dates
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Enumeration Date | 09/05/2016
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 636 CHURCH ST STE 511
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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 | 773-972-5844
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Fax | 847-440-9036
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Provider Business Mailing Address
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Address Line | 636 CHURCH ST STE 511
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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 | 773-972-5844
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Fax | 847-440-9036
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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 | 180010702
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License Number State | IL
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