Provider Demographics
NPI:1003590035
Name:BRUNHAVER, KATHRINE (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:BRUNHAVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 N WINCHESTER AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-0920
Mailing Address - Country:US
Mailing Address - Phone:618-795-9878
Mailing Address - Fax:
Practice Address - Street 1:1801 W WARNER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1891
Practice Address - Country:US
Practice Address - Phone:773-217-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional