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General NPI Number Information
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NPI Number | 1861923567
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Entity Type | Organization
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Legal Business Name | KRE BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 930 175TH ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-2039
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Country | US
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Telephone | 773-530-4077
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Fax |
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Provider Business Mailing Address
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Address Line | 8114 S KENWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60619-3415
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Country | US
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Telephone | 773-531-4288
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KECIA EVANS
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Credential | EDD, LCPC, CADC
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Telephone | 773-530-4077
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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 | 180008868
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License Number State | IL
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