Provider Demographics
NPI:1154989895
Name:AUDRA KURTH, LLC
Entity type:Organization
Organization Name:AUDRA KURTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KURTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-287-7216
Mailing Address - Street 1:2737 W AINSLIE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2715
Mailing Address - Country:US
Mailing Address - Phone:309-287-7216
Mailing Address - Fax:
Practice Address - Street 1:4054 N LINCOLN AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3038
Practice Address - Country:US
Practice Address - Phone:309-287-7216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty