MEDICARE: KRISTIN FELL

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	1041C0700X	Clinical Social Worker
4	251S00000X	Community/Behavioral Health Agency	150006696	IL
5	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1770930497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN FELL

Provider Business Mailing Address
First Line	:	859 BIG BEAR TRL
Second Line	:
City	:	CARY
State	:	IL
Zip	:	60013-3303
Country	:	US
Telephone Number	:	847-757-9012
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 S VIRGINIA ST
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7226
Country	:	US
Telephone Number	:	815-444-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	02/03/2026

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Directions to “ KRISTIN FELL ” Practice Location

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