Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 180.005444 | IL |
N | 101YP1600X | Pastoral Counselor | 180.005444 | IL |
Y | 101YP2500X | Professional Counselor | 180.005444 | IL |
NPI | 1245648708 |
---|---|
Provider Name | Dr. Lisa Michelle Kohut |
First Address | Mundelein, IL 60060-4111 |
Second Address | Mount Prospect, IL 60056-3457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2014 |
Last Update Date | 08/02/2017 |