Active NPI
Kelly A Kazukauskas, PHD, LCPC, CRC, CVE
- Professional Counselor
- Chicago, IL
National Provider Identifier
1053588749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180.008591
- Practice address
- 3105 S Dearborn St
Suite 252
Chicago, IL 60616-2852 - Phone
- (708) 949-6466
- NPI assigned
- May 12, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.008591 | IL | Primary |
Addresses
Primary practice location
3105 S Dearborn St
Suite 252
Chicago, IL 60616-2852
Mailing address
13602 S Tara Dr
Homer Glen, IL 60491-9172
Phone (312) 933-1162
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.008591 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kelly Kazukauskas Clinical Professional Counseling, LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Professional Counselor
- Chicago, IL
- NPI 1831585751
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431561600000",
"number": "1053588749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13602 S TARA DR",
"city": "HOMER GLEN",
"state": "IL",
"postal_code": "604919172",
"telephone_number": "312-933-1162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3105 S DEARBORN ST",
"address_2": "SUITE 252",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606162852",
"telephone_number": "708-949-6466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAZUKAUSKAS",
"first_name": "KELLY",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PHD, LCPC, CRC, CVE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-12",
"last_updated": "2015-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180.008591",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.