Provider Demographics
NPI:1134555881
Name:KAVRAN, ALIX (LCPC)
Entity type:Individual
Prefix:
First Name:ALIX
Middle Name:
Last Name:KAVRAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ALIX
Other - Middle Name:
Other - Last Name:CARDOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7310 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3902
Mailing Address - Country:US
Mailing Address - Phone:779-210-4987
Mailing Address - Fax:
Practice Address - Street 1:7310 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3902
Practice Address - Country:US
Practice Address - Phone:779-210-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7165-125101Y00000X
101Y00000X
IL180010697101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor