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General NPI Number Information
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NPI Number | 1952896680
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Entity Type | Individual
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Provider Name | KRISTIN LEE NIELSEN MA, MACL, LPC
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Gender | Female
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 820 W JACKSON BLVD STE 515
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City | CHICAGO
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State | IL
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Zip | 60607-3061
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Country | US
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Telephone | 312-718-3336
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 QUAIL RUN RD APT 415
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City | RIVERSIDE
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State | CA
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Zip | 92507-6068
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Country | US
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Telephone | 847-977-6069
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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 | 178012410
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License Number State | IL
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