Provider Demographics
NPI:1508675984
Name:K RENA GROUP
Entity type:Organization
Organization Name:K RENA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR - CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:KENYON
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-388-9182
Mailing Address - Street 1:8850 S LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-5940
Mailing Address - Country:US
Mailing Address - Phone:312-388-9182
Mailing Address - Fax:
Practice Address - Street 1:2525 S WABASH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2308
Practice Address - Country:US
Practice Address - Phone:312-388-9182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty