Provider Demographics
NPI:1568199719
Name:KIM, JI MIN (LCPC)
Entity Type:Individual
Prefix:
First Name:JI MIN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 S ARCHER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1844
Mailing Address - Country:US
Mailing Address - Phone:571-355-3074
Mailing Address - Fax:
Practice Address - Street 1:2150 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4598
Practice Address - Country:US
Practice Address - Phone:630-752-9874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty