Provider Demographics
NPI:1265136147
Name:KAPWA ART THERAPY AND COUNSELING
Entity type:Organization
Organization Name:KAPWA ART THERAPY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FREDELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, ATR-BC
Authorized Official - Phone:773-931-8897
Mailing Address - Street 1:3214 W LELAND AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-8575
Mailing Address - Country:US
Mailing Address - Phone:773-931-8897
Mailing Address - Fax:
Practice Address - Street 1:3214 W LELAND AVE APT 1A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-8575
Practice Address - Country:US
Practice Address - Phone:773-931-8897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty