Provider Demographics
NPI:1154550333
Name:KYLES, QUINCEY F (LCSW)
Entity type:Individual
Prefix:MR
First Name:QUINCEY
Middle Name:F
Last Name:KYLES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 W MONTROSE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1674
Mailing Address - Country:US
Mailing Address - Phone:404-543-5654
Mailing Address - Fax:312-275-7564
Practice Address - Street 1:2650 W MONTROSE AVE STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1674
Practice Address - Country:US
Practice Address - Phone:404-543-5654
Practice Address - Fax:312-275-7564
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490153491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical