Charles Kimball
Individual provider Active NPI Marriage & Family Therapist · Chicago, IL
NPI 1679320774 · NPPES record last updated May 6, 2024
Key facts
- NPI
- 1679320774
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- Practice address
- 939 W North Ave Ste 750
Chicago, IL 60642-7142 - Phone
- (312) 600-0409
- NPI assigned
- May 6, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avid Intimacy, LLC | Marriage & Family Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | Yes |
Addresses
Primary practice location
939 W North Ave Ste 750
Chicago, IL 60642-7142
Mailing address
3923 W Schubert Ave Apt 1
Chicago, IL 60647-8139
Phone (530) 304-2612
Other providers in Chicago, IL
- Yunji Kim
- Yurie Kim
- Zin Young Kim
- Kimball Ladien,MD
- Kimball Medical Center SC
- John Kimball
- Kimberly M Egly LTD
- Kimberly Mathis-Harris
- Kimberly Smiles
- Kimberly Vander Griend LCSW LTD
All providers in Chicago, IL · Marriage & Family Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.