Active NPI
Theresa Lynne Kish, LCPC
- Professional Counselor
- Yorkville, IL
National Provider Identifier
1528201423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180-002412
- Practice address
- 624 W Veterans Pkwy
Suite D
Yorkville, IL 60560-4567 - Phone
- (630) 552-5643
- Fax
- (630) 689-1161
- NPI assigned
- Apr 8, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 | 180-002412 | IL | Primary |
Addresses
Primary practice location
624 W Veterans Pkwy
Suite D
Yorkville, IL 60560-4567
Mailing address
624 W Veterans Pkwy
Suite D
Yorkville, IL 60560-4567
Phone (630) 552-5643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180-002412 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richard Kneip, PH.D., P.C. | 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.
-
- Community/Behavioral Health Agency
- Clarkston, MI
- NPI 1679739700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239148800000",
"number": "1528201423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "624 W VETERANS PKWY",
"address_2": "SUITE D",
"city": "YORKVILLE",
"state": "IL",
"postal_code": "605604567",
"telephone_number": "630-552-5643",
"fax_number": "630-689-1161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "624 W VETERANS PKWY",
"address_2": "SUITE D",
"city": "YORKVILLE",
"state": "IL",
"postal_code": "605604567",
"telephone_number": "630-552-5643",
"fax_number": "630-689-1161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISH",
"first_name": "THERESA",
"middle_name": "LYNNE",
"credential": "LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-08",
"last_updated": "2009-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180-002412",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yorkville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.