Provider Demographics
NPI:1215963020
Name:CALHOUN, KIMBERLY A (LCPC,CRC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:LCPC,CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 LAKEWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3352
Mailing Address - Country:US
Mailing Address - Phone:815-942-6323
Mailing Address - Fax:815-941-0308
Practice Address - Street 1:1401 LAKEWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3352
Practice Address - Country:US
Practice Address - Phone:815-942-6323
Practice Address - Fax:815-941-0308
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health