Provider Demographics
NPI:1457797987
Name:KURTH, AUDRA ELIZABETH (LCPC)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:ELIZABETH
Last Name:KURTH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 W AINSLIE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2715
Mailing Address - Country:US
Mailing Address - Phone:309-287-7216
Mailing Address - Fax:
Practice Address - Street 1:4054 N LINCOLN AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3038
Practice Address - Country:US
Practice Address - Phone:309-287-7216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.0086361041C0700X
IL180008636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical