Provider Demographics
NPI:1770064776
Name:SHIVER, KYLE (LPC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SHIVER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 N ALBANY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4203
Mailing Address - Country:US
Mailing Address - Phone:773-484-0329
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE STE 531
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7426
Practice Address - Country:US
Practice Address - Phone:773-484-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013987101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL900475647OtherINNERVOICE PSYCHOTHERAPY & CONSULTATION