Provider Demographics
NPI:1245581743
Name:LOWE KERNEY, LATRELLE (LCPC)
Entity Type:Individual
Prefix:
First Name:LATRELLE
Middle Name:
Last Name:LOWE KERNEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 S COTTAGE GROVE AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3514
Mailing Address - Country:US
Mailing Address - Phone:312-747-0036
Mailing Address - Fax:
Practice Address - Street 1:4314 S COTTAGE GROVE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3514
Practice Address - Country:US
Practice Address - Phone:312-747-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional