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General NPI Number Information
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NPI Number | 1902170574
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Entity Type | Individual
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Provider Name | KYLE STEPHANIE KING LMFT, LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 1580 N NORTHWEST HWY SUITE 305A
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City | PARK RIDGE
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State | IL
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Zip | 60068-1444
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Country | US
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Telephone | 224-636-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 850 W PANORAMA DR APT 209
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City | PALATINE
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State | IL
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Zip | 60067-0621
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Country | US
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Telephone | 224-636-1212
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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 | 180007197
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166000721
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License Number State | IL
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