Provider Demographics
NPI:1215362686
Name:FARRELL, KATHLEEN (LCPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:FARRELL
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 1:1960 N LINCOLN PARK W
Mailing Address - Street 2:APT. 2312
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5487
Mailing Address - Country:US
Mailing Address - Phone:773-282-0077
Mailing Address - Fax:
Practice Address - Street 1:1960 N LINCOLN PARK W
Practice Address - Street 2:APT. 2312
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5487
Practice Address - Country:US
Practice Address - Phone:773-282-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional