Provider Demographics
NPI:1811450208
Name:KUSH, JESSICA L (LCPC, CCTP, TCTSY-F)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:KUSH
Suffix:
Gender:F
Credentials:LCPC, CCTP, TCTSY-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 S 84TH AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-3223
Mailing Address - Country:US
Mailing Address - Phone:815-823-6950
Mailing Address - Fax:
Practice Address - Street 1:200 S FRONTAGE RD STE 320
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6953
Practice Address - Country:US
Practice Address - Phone:630-423-5998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional