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General NPI Number Information
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NPI Number | 1497495246
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Entity Type | Individual
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Provider Name | KYLIE MARIE VAN KOEVERING LCSW
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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 | 09/12/2024
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Provider Practice Location Address
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Address Line | 5215 N CALIFORNIA AVE STE F101
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City | CHICAGO
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State | IL
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Zip | 60625-0035
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Country | US
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Telephone | 773-561-5946
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Fax |
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Provider Business Mailing Address
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Address Line | 5215 N CALIFORNIA AVE STE F101
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City | CHICAGO
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State | IL
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Zip | 60625-0035
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Country | US
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Telephone | 773-561-5946
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149.027729
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.027729
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License Number State | IL
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