Kevin Crystal, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180010702 Issued in IL

Practice address

636 Church St Ste 511
Evanston, IL 60201-4581

Phone

(773) 972-5844

Fax

(847) 440-9036

NPI assigned

Sep 5, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Kevin Crystal Counseling P.C.

  • Mental Health Counselor
  • Evanston, IL
  • NPI 1073440764
  NPD Authorized official

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

{
    "created_epoch": "1473033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1356898647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST STE 511",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014581",
            "telephone_number": "773-972-5844",
            "fax_number": "847-440-9036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST STE 511",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014581",
            "telephone_number": "773-972-5844",
            "fax_number": "847-440-9036"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1821 Simpson St",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602013041",
            "country_code": "US",
            "telephone_number": "773-972-5844",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1609 Sherman Ave Ste 318",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602013753",
            "country_code": "US",
            "telephone_number": "847-440-4838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRYSTAL",
        "first_name": "KEVIN",
        "name_prefix": "Mr.",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-05",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180010702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; 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.