MEDICARE: KT COUNSELING 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1699233478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KT COUNSELING LLC

Provider Business Mailing Address
First Line	:	1401 MAYFIELD LN
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-2634
Country	:	US
Telephone Number	:	847-885-8991
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 GRAND CANYON PKWY STE 420
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1737
Country	:	US
Telephone Number	:	330-704-7287
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATIE FORSYTHE
Credential	:
Telephone Number	:	330-704-7287

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	03/11/2019

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