Provider Demographics
NPI:1699312835
Name:KLARA, KATHERINE ELIZABETH (LCPC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:KLARA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:PITLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7810 DANBURY DR
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4351
Mailing Address - Country:US
Mailing Address - Phone:630-484-6051
Mailing Address - Fax:
Practice Address - Street 1:72 S LA GRANGE RD STE 9
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6318
Practice Address - Country:US
Practice Address - Phone:630-484-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012310101YM0800X
IL180.012310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health