Provider Demographics
NPI:1639649007
Name:KATHY KAROUZOS COUNSELING, LLC
Entity Type:Organization
Organization Name:KATHY KAROUZOS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KAROUZOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:618-334-0604
Mailing Address - Street 1:330 W. IVY LN.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:618-334-0604
Mailing Address - Fax:
Practice Address - Street 1:330 W. IVY LN.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:618-334-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health