K Rena Group

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

K RENA GROUP

Doing business as

Kenyon Douglass

Practice address

2525 S Wabash Ave
Chicago, IL 60616-2308

Phone

(312) 388-9182

NPI assigned

Dec 31, 2024

Last updated

Dec 31, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Kenyon R Douglass, LCPCNPI 1215002050

Title

Owner/Operator - Ceo

Phone

(312) 388-9182

Specialties & licenses 5

Addresses

Other names 1

• Kenyon Douglass Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kenyon Rena Douglass, LCPC

  • Professional Counselor
  • Chicago, IL
  • NPI 1215002050
  NPD Authorized official

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

{
    "created_epoch": "1735603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1508675984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8850 S LONGWOOD DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606435940",
            "telephone_number": "312-388-9182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 S WABASH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162308",
            "telephone_number": "312-388-9182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K RENA GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-31",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "DOUGLASS",
        "authorized_official_first_name": "KENYON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/OPERATOR - CEO",
        "authorized_official_telephone_number": "312-388-9182",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenyon Douglass",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mental Health Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; 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.