Provider Demographics
NPI:1992946354
Name:KINISON, RACHEL (LCPC, LMHC)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:KINISON
Suffix:
Gender:F
Credentials:LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 NORTHWAY PARK RD APT 5
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-2012
Mailing Address - Country:US
Mailing Address - Phone:815-540-1785
Mailing Address - Fax:
Practice Address - Street 1:233 NORTHWAY PARK RD APT 5
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-2012
Practice Address - Country:US
Practice Address - Phone:815-540-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001622101YM0800X
IL180007037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health