Provider Demographics
NPI:1891928792
Name:FORAKER-KOONS, KIMANNE (MA, AMFT)
Entity Type:Individual
Prefix:MRS
First Name:KIMANNE
Middle Name:
Last Name:FORAKER-KOONS
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18161 MORRIS AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2108
Mailing Address - Country:US
Mailing Address - Phone:708-798-5433
Mailing Address - Fax:708-798-5706
Practice Address - Street 1:18161 MORRIS AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2108
Practice Address - Country:US
Practice Address - Phone:708-798-5433
Practice Address - Fax:708-798-5706
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist