Provider Demographics
NPI:1851756621
Name:KIM, INKYUNG-YULEEI (LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:INKYUNG-YULEEI
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:YULEE
Other - Middle Name:INKYUNG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC, CADC
Mailing Address - Street 1:5910 W. DIVISION ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651
Mailing Address - Country:US
Mailing Address - Phone:773-777-7112
Mailing Address - Fax:773-887-3300
Practice Address - Street 1:5910 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-1031
Practice Address - Country:US
Practice Address - Phone:773-777-7112
Practice Address - Fax:773-887-3300
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22125101YA0400X
IL180.006047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)