Provider Demographics
NPI:1538646203
Name:KIND LIVING THERAPY, LLC
Entity Type:Organization
Organization Name:KIND LIVING THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-844-2644
Mailing Address - Street 1:210 W WATER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1790
Mailing Address - Country:US
Mailing Address - Phone:815-844-2644
Mailing Address - Fax:
Practice Address - Street 1:210 W WATER ST STE 1
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1790
Practice Address - Country:US
Practice Address - Phone:815-844-2644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty