Provider Demographics
NPI:1215351747
Name:PETERS, KRISTIN MARIE (LCPC, LPC, SAC)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MARIE
Last Name:PETERS
Suffix:
Gender:
Credentials:LCPC, LPC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15219
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5140
Mailing Address - Country:US
Mailing Address - Phone:773-643-6259
Mailing Address - Fax:
Practice Address - Street 1:5536 S EVERETT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1902
Practice Address - Country:US
Practice Address - Phone:773-643-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6336-125101YP2500X
IL180.014620101YP2500X
WI16331101Y00000X
WI15975-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)