Provider Demographics
NPI:1386384410
Name:BRAND, KELLIE (LCPC)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:BRAND
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E JACKSON BLVD STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4184
Mailing Address - Country:US
Mailing Address - Phone:131-266-3113
Mailing Address - Fax:
Practice Address - Street 1:2200 LAKE VICTORIA DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5596
Practice Address - Country:US
Practice Address - Phone:312-663-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178017539101YP2500X
IL180015546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional