Provider Demographics
NPI:1750523973
Name:MONAHAN, KRISTIN RUTH (MA LCPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:RUTH
Last Name:MONAHAN
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 1:4403 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-9344
Mailing Address - Country:US
Mailing Address - Phone:217-954-1642
Mailing Address - Fax:
Practice Address - Street 1:202 W. PARK ST.
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3929
Practice Address - Country:US
Practice Address - Phone:217-373-2436
Practice Address - Fax:217-373-2443
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional