Provider Demographics
NPI:1629491261
Name:KIOUSSIS, NICOLE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:KIOUSSIS
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 1:8727 BELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1825
Mailing Address - Country:US
Mailing Address - Phone:312-730-0361
Mailing Address - Fax:
Practice Address - Street 1:625 SLAWIN CT
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2183
Practice Address - Country:US
Practice Address - Phone:312-730-0361
Practice Address - Fax:224-999-7566
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011702101YP2500X
IL00117978101Y00000X
IL178.009689101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor