MEDICARE: KB & ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	149.016080	IL

General Provider Information

NPI Number	:	1194228171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KB & ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2451 N LINCOLN AVE STE 209
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2422
Country	:	US
Telephone Number	:	773-658-9494
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 N LINCOLN AVE STE 209
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2422
Country	:	US
Telephone Number	:	773-658-9494
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	KASHARA WARREN
Credential	:	LCSW
Telephone Number	:	734-262-6867

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	03/15/2018

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