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General NPI Number Information
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NPI Number | 1720669534
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Entity Type | Organization
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Legal Business Name | KIN THERAPY COLLECTIVE PLLC
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 4633 N WESTERN AVE STE 200
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City | CHICAGO
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State | IL
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Zip | 60625-2181
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Country | US
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Telephone | 302-230-1531
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Fax |
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Provider Business Mailing Address
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Address Line | 5718 N WINTHROP AVE APT 608
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City | CHICAGO
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State | IL
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Zip | 60660-4370
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Country | US
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Telephone | 302-230-1531
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | SOPHIA CATHERINE BURKE
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Credential | LCPC
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Telephone | 302-230-1531
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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 |
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License Number State |
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