Provider Demographics
NPI:1164693651
Name:CAMILLE-MCKINESS, KRISTY (EDD, LCPC, ACS)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:CAMILLE-MCKINESS
Suffix:
Gender:F
Credentials:EDD, LCPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N. FARNSWORTH AVE,
Mailing Address - Street 2:SUITE 21
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505
Mailing Address - Country:US
Mailing Address - Phone:331-213-9706
Mailing Address - Fax:630-692-4136
Practice Address - Street 1:1700 N. FARNSWORTH AVE,
Practice Address - Street 2:SUITE 21
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505
Practice Address - Country:US
Practice Address - Phone:331-213-9706
Practice Address - Fax:630-692-4136
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178005432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health