Provider Demographics
NPI:1225502131
Name:BERRY, KATIE (LCPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:708 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-9130
Mailing Address - Country:US
Mailing Address - Phone:630-779-1305
Mailing Address - Fax:
Practice Address - Street 1:708 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-9130
Practice Address - Country:US
Practice Address - Phone:630-779-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health