Provider Demographics
NPI:1336684976
Name:TEBBENS, CAROLINE KENERSON (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:KENERSON
Last Name:TEBBENS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 N CLARK ST APT 801
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5855
Mailing Address - Country:US
Mailing Address - Phone:978-302-5257
Mailing Address - Fax:
Practice Address - Street 1:5225 OLD ORCHARD RD STE 37
Practice Address - Street 2:SKYLIGHT COUNSELING CENTER
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1027
Practice Address - Country:US
Practice Address - Phone:847-529-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health