Provider Demographics
NPI:1073840740
Name:KGH CONSULTATION & TREATMENT, INC.
Entity Type:Organization
Organization Name:KGH CONSULTATION & TREATMENT, INC.
Other - Org Name:KGH AUTISM SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:GARVEY
Authorized Official - Last Name:HOEHNE
Authorized Official - Suffix:
Authorized Official - Credentials:MA,BCBA
Authorized Official - Phone:847-498-5437
Mailing Address - Street 1:1161 LAKE COOK RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5649
Mailing Address - Country:US
Mailing Address - Phone:847-498-5437
Mailing Address - Fax:847-498-5438
Practice Address - Street 1:1161 LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5649
Practice Address - Country:US
Practice Address - Phone:847-498-5437
Practice Address - Fax:847-498-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2022-03-09
Deactivation Date:2020-04-23
Deactivation Code:
Reactivation Date:2020-05-11
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103K00000X, 103TC2200X, 106S00000X, 225X00000X, 235Z00000X
WI612826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty