Provider Demographics
NPI:1225671019
Name:KIRCHNER, COLIN D (LPC)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:D
Last Name:KIRCHNER
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 1:540 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60484-2903
Mailing Address - Country:US
Mailing Address - Phone:708-497-0293
Mailing Address - Fax:
Practice Address - Street 1:540 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:IL
Practice Address - Zip Code:60484
Practice Address - Country:US
Practice Address - Phone:708-497-0293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.015128101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional