Provider Demographics
NPI:1184013930
Name:KM INSTITUTE, LLC.
Entity Type:Organization
Organization Name:KM INSTITUTE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMILLE-MCKINESS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD LCPC
Authorized Official - Phone:331-213-9706
Mailing Address - Street 1:1444 N FARNSWORTH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-1642
Mailing Address - Country:US
Mailing Address - Phone:331-213-9706
Mailing Address - Fax:
Practice Address - Street 1:1444 N FARNSWORTH AVE STE 304
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-1642
Practice Address - Country:US
Practice Address - Phone:331-213-9706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty