Provider Demographics
NPI:1063027894
Name:TACIA, KYLE (LPC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:TACIA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 N SHERIDAN RD APT 710
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6562
Mailing Address - Country:US
Mailing Address - Phone:808-729-2556
Mailing Address - Fax:
Practice Address - Street 1:9875 W LINCOLN HWY STE 202
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1930
Practice Address - Country:US
Practice Address - Phone:630-281-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty