Provider Demographics
NPI:1114679511
Name:KINESPHERE COUNSELING LLC
Entity Type:Organization
Organization Name:KINESPHERE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGLIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-525-6152
Mailing Address - Street 1:3634 N TRIPP AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3037
Mailing Address - Country:US
Mailing Address - Phone:708-525-6152
Mailing Address - Fax:
Practice Address - Street 1:3166 N LINCOLN AVE STE 307
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3119
Practice Address - Country:US
Practice Address - Phone:708-525-6152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty