Provider Demographics
NPI:1790165389
Name:CAROLLYN MCKINSTRY
Entity Type:Organization
Organization Name:CAROLLYN MCKINSTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINSTRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-618-4152
Mailing Address - Street 1:773 W LINCOLN BLVD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4978
Mailing Address - Country:US
Mailing Address - Phone:815-618-4152
Mailing Address - Fax:
Practice Address - Street 1:773 W LINCOLN ST
Practice Address - Street 2:SUITE 201A
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4976
Practice Address - Country:US
Practice Address - Phone:815-618-4152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty