Provider Demographics
NPI:1326816240
Name:QANDEEL-KISHTA, HEBA I (MA, CADC I)
Entity Type:Individual
Prefix:
First Name:HEBA
Middle Name:I
Last Name:QANDEEL-KISHTA
Suffix:
Gender:F
Credentials:MA, CADC I
Other - Prefix:
Other - First Name:HEBA
Other - Middle Name:I
Other - Last Name:QANDEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CADC
Mailing Address - Street 1:7625 BROOKSIDE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5197
Mailing Address - Country:US
Mailing Address - Phone:312-371-9222
Mailing Address - Fax:
Practice Address - Street 1:7625 BROOKSIDE GLEN DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-5197
Practice Address - Country:US
Practice Address - Phone:312-371-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 102L00000X, 103K00000X, 106E00000X, 146N00000X, 171400000X, 171M00000X, 171R00000X, 171W00000X, 1744G0900X, 1744R1102X, 251S00000X, 372600000X
IL33823101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171R00000XOther Service ProvidersInterpreter
No171W00000XOther Service ProvidersContractor
No1744G0900XOther Service ProvidersSpecialistGraphics Designer
No1744R1102XOther Service ProvidersSpecialistResearch Study
No251S00000XAgenciesCommunity/Behavioral Health
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL156547002Medicaid