Provider Demographics
NPI:1952896680
Name:NIELSEN, KRISTIN LEE (MA, MACL, LPC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LEE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MA, MACL, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 QUAIL RUN RD APT 415
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6068
Mailing Address - Country:US
Mailing Address - Phone:847-977-6069
Mailing Address - Fax:
Practice Address - Street 1:820 W JACKSON BLVD STE 515
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3061
Practice Address - Country:US
Practice Address - Phone:312-718-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional