Provider Demographics
NPI:1831556687
Name:NEWHALL, KEVIN ALLEN (LCSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ALLEN
Last Name:NEWHALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N NOBLE ST APT 105
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-7400
Mailing Address - Country:US
Mailing Address - Phone:773-909-9096
Mailing Address - Fax:
Practice Address - Street 1:515 N NOBLE ST APT 105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-7400
Practice Address - Country:US
Practice Address - Phone:773-909-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.015028104100000X
IL149.018631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker