MEDICARE: KMCD COUNSELING PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1366211492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMCD COUNSELING PLLC

Provider Business Mailing Address
First Line	:	5912 EL MORRO LN
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-1922
Country	:	US
Telephone Number	:	708-560-3069
Fax Number	:

Provider Business Practice Location Address
First Line	:	5912 EL MORRO LN
Second Line	:
City	:	OAK FOREST
State	:	IL
Zip	:	60452-1922
Country	:	US
Telephone Number	:	708-560-3069
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KELSEY M DAGENAIS
Credential	:	LCPC
Telephone Number	:	708-560-3069

Provider Enumeration Date	:	12/29/2023
Last Update Date	:	12/29/2023

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