Kyle Tanner, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180013001 Issued in IL

Practice address

1053 W Grace St Apt 2E
Chicago, IL 60613-5082

Phone

(843) 450-5953

NPI assigned

May 3, 2021

Last updated

May 3, 2021By the provider in NPPES

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

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1679156046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 MADISON ST",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601301726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1053 W GRACE ST APT 2E",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606135082",
            "telephone_number": "843-450-5953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "KYLE",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180013001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Tannenbaum, LCSW
• Beth Anne Tanner, AU.D.
• Camisha Tanner, PHARMD
• Casey Walton Tanner, LCPC
• Christina Tanner, C.N.M.
• Latoya D. Tanniehill, LCSW
• Alexa Harris Tannous, PA-C
• Paul Tannous, M.D., PH.D.
• Pornthep Tanpowpong, M.D.
• Michael J Tansey, PH.D.

• 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 May 3, 2021; 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.