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General NPI Number Information
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NPI Number | 1982317970
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Entity Type | Individual
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Provider Name | KEVIN THOMAS
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Gender | Male
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Dates
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Enumeration Date | 01/04/2023
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 2451 N LINCOLN AVE STE 206
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City | CHICAGO
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State | IL
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Zip | 60614-2422
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Country | US
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Telephone | 888-428-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 1853 W 37TH ST APT 3
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City | CHICAGO
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State | IL
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Zip | 60609-2019
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Country | US
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Telephone | 779-475-3371
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 178.018702
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License Number State | IL
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