Basic Information
| Provider Information | |||||||||
| NPI: | 1902195530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAUCIG | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCPC, CRC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 W DAYTON ST | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153441230 | ||||||||
| FaxNumber: | 8153443815 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 W DAYTON ST | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153441230 | ||||||||
| FaxNumber: | 8153443815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2011 | ||||||||
| LastUpdateDate: | 04/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 180003328 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 180003328 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 180-003328 | 01 | IL | LICENSED CLINICAL PROFESSIONAL COUNSELOR | OTHER |