Provider Demographics
NPI:1063129765
Name:SEELBACH, KATHLEEN ANN (LCPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:SEELBACH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1418
Mailing Address - Country:US
Mailing Address - Phone:217-971-0169
Mailing Address - Fax:
Practice Address - Street 1:2201 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1418
Practice Address - Country:US
Practice Address - Phone:217-971-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180-003843OtherILLINOIS DEPT OF FINANCIAL AND PROFESSIONAL REGULATION