Provider Demographics
NPI:1366211492
Name:KMCD COUNSELING PLLC
Entity type:Organization
Organization Name:KMCD COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAGENAIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-560-3069
Mailing Address - Street 1:5912 EL MORRO LN
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1922
Mailing Address - Country:US
Mailing Address - Phone:708-560-3069
Mailing Address - Fax:
Practice Address - Street 1:5912 EL MORRO LN
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1922
Practice Address - Country:US
Practice Address - Phone:708-560-3069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty