Provider Demographics
NPI:1437512233
Name:KOONTZ, RORY (LPC)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:
Last Name:KOONTZ
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 1:2328 N ROCKWELL ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3006
Mailing Address - Country:US
Mailing Address - Phone:217-825-6070
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE 2130
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-416-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011912101YP2500X
IL180011287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional