Provider Demographics
NPI:1801271200
Name:CHIN, KATHLEEN SUSAN (LPC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:CHIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1901 N PROSPECT AVE
Mailing Address - Street 2:APT. 401
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1486
Mailing Address - Country:US
Mailing Address - Phone:262-894-0226
Mailing Address - Fax:
Practice Address - Street 1:5757 W OKLAHOMA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-4303
Practice Address - Country:US
Practice Address - Phone:414-431-6400
Practice Address - Fax:414-431-6401
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional