Provider Demographics
NPI:1295984516
Name:DE VRIES, KATHY J (MA, LCPC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:DE VRIES
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9721 W. 165TH ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-4511
Mailing Address - Country:US
Mailing Address - Phone:708-846-6986
Mailing Address - Fax:708-460-0300
Practice Address - Street 1:9721 W 165TH ST
Practice Address - Street 2:SUITE 23
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4511
Practice Address - Country:US
Practice Address - Phone:708-846-6986
Practice Address - Fax:708-460-0300
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007790101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional