Provider Demographics
NPI:1316345770
Name:VER KUILEN, VINCENT CARL (MSED LCPC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:CARL
Last Name:VER KUILEN
Suffix:
Gender:M
Credentials:MSED LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-7695
Mailing Address - Country:US
Mailing Address - Phone:815-670-1397
Mailing Address - Fax:
Practice Address - Street 1:6410 HARVEST LN
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-7695
Practice Address - Country:US
Practice Address - Phone:815-670-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180009433OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION