Kathleen Ann Odwyer, MA, MED.,LCPC, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

180.015861 Issued in IL

Practice address

3317 W 95TH St Ste 101
Evergreen Park, IL 60805-2243

Phone

(708) 529-3011

Fax

(708) 529-3207

NPI assigned

May 21, 2019

Sex

Female

Sole proprietor

No

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

Credentials

Master of Arts, Master of Education

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.

• Southside Counseling Services, LLC

  • Mental Health Counselor
  • Tinley Park, IL
  • NPI 1992560627
  NPD Authorized official

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

{
    "created_epoch": "1558396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1649837188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3317 W 95TH ST STE 101",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052243",
            "telephone_number": "708-529-3011",
            "fax_number": "708-529-3207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3317 W 95TH ST STE 101",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052243",
            "telephone_number": "708-529-3011",
            "fax_number": "708-529-3207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6825 167th St Ste 4",
            "address_purpose": "LOCATION",
            "city": "Tinley Park",
            "state": "IL",
            "postal_code": "604772501",
            "country_code": "US",
            "telephone_number": "708-268-4468",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODWYER",
        "first_name": "KATHLEEN",
        "middle_name": "ANN",
        "credential": "MA, MED.,LCPC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-21",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180.015861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ejikeme O Obasi, MD
• Irwin Douglas Obispo
• Occupational Therapy Providers Inc.
• Richard E Odonnell, DO
• Odonoghue & Rosenow, MDSC
• Adedotun A. Ogunsua, M.D.
• Oliver Drabkin M.D. S.C.
• Nancy Ann Olsen, APN
• Jessica L Olson, LCPC
• Iyad S Omar, R.D.H, B.S.

• Mental Health Counselor in Evergreen Park, IL
• Providers in Evergreen Park, 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 Feb 21, 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.