Kenyon Rena Douglass, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180004106 Issued in IL

Practice address

1525 E 53Rd St
Suite 429
Chicago, IL 60615-4557

Phone

(312) 388-9182

NPI assigned

Nov 21, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• K Rena Group

  dba Kenyon Douglass

  • Mental Health Counselor
  • Chicago, IL
  • NPI 1508675984
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215002050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4518 S INDIANA AVE",
            "address_2": "UNIT 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606533908",
            "telephone_number": "773-624-9878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E 53RD ST",
            "address_2": "SUITE 429",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154557",
            "telephone_number": "312-388-9182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "KENYON",
        "middle_name": "RENA",
        "name_prefix": "Miss",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180004106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN HEALTH",
            "identifier": "567052000",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "1634163",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Michelle Douglas, D.M.D.
• Megan Douglas
• Natalie BK Douglas, BA, MS, DT, RBT
• Sara Douglas
• Karen Yvette Douglass, PSY.D
• Laura Douglass
• Hillary Douin, LCSW
• Rami Doukky, M.D.
• Stavros Alexandros Petros Doumas, MD
• Ameenah Doumbia

• Professional Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.