Provider Demographics
NPI:1316359318
Name:MAHAR, KRISTEN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MAHAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-0665
Mailing Address - Country:US
Mailing Address - Phone:815-725-5188
Mailing Address - Fax:815-725-7550
Practice Address - Street 1:621 ROLLINGWOOD DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-0665
Practice Address - Country:US
Practice Address - Phone:815-725-5188
Practice Address - Fax:815-725-7550
Is Sole Proprietor?:No
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008468101YP2500X
IL2369246101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool