Provider Demographics
NPI:1477888576
Name:DURIS, KIMBERLY SHANNON (LCPC, CADC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SHANNON
Last Name:DURIS
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5432
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-5432
Mailing Address - Country:US
Mailing Address - Phone:630-862-0760
Mailing Address - Fax:
Practice Address - Street 1:1701 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-2130
Practice Address - Country:US
Practice Address - Phone:630-221-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005818101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health