Provider Demographics
NPI:1891961314
Name:THUMME, KATHRYN ASHA (LMFT, CST)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ASHA
Last Name:THUMME
Suffix:
Gender:F
Credentials:LMFT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ATKINSON RD STE 112E
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7805
Mailing Address - Country:US
Mailing Address - Phone:847-682-0290
Mailing Address - Fax:
Practice Address - Street 1:100 N ATKINSON RD STE 112E
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7805
Practice Address - Country:US
Practice Address - Phone:847-682-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000760106H00000X
WI806-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist