Provider Demographics
NPI:1891519559
Name:PUENTE, KRISTINE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:PUENTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8643 ROCKEFELLER AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1414
Mailing Address - Country:US
Mailing Address - Phone:708-703-1591
Mailing Address - Fax:
Practice Address - Street 1:1919 S HIGHLAND AVE STE 325A
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6181
Practice Address - Country:US
Practice Address - Phone:630-613-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.019626101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional