Provider Demographics
NPI:1801480629
Name:KEUBEN, KYRA LEE (LCSW)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:LEE
Last Name:KEUBEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 N AVERS AVE APT 3R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5214
Mailing Address - Country:US
Mailing Address - Phone:630-740-7074
Mailing Address - Fax:
Practice Address - Street 1:4800 N MILWAUKEE AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2156
Practice Address - Country:US
Practice Address - Phone:773-234-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0225521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical