Provider Demographics
NPI:1497539266
Name:KAINOS COUNSELING AND CONSULTATION, PLLC
Entity Type:Organization
Organization Name:KAINOS COUNSELING AND CONSULTATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DALLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, EMDR
Authorized Official - Phone:253-223-5468
Mailing Address - Street 1:26W068 JEWELL RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3931
Mailing Address - Country:US
Mailing Address - Phone:253-223-5468
Mailing Address - Fax:
Practice Address - Street 1:800 ROOSEVELT RD BLDG. E
Practice Address - Street 2:STE 410, #8
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5839
Practice Address - Country:US
Practice Address - Phone:630-216-9201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health