Individual
MRS. CAROLINE KELLY TYE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, ATR-BC
Contact information
Practice address
2630 W FLETCHER ST, CHICAGO, IL 60618-7110
(847) 651-8643
Mailing address
904 SEWARD ST, APT #3, EVANSTON, IL 60202-5321
(847) 651-8643
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
178012176
IL
101YP2500X
Professional Counselor
Primary
180011239
IL
221700000X
Art Therapist
16-069
IL
Other
Enumeration date
09/04/2016
Last updated
11/28/2017
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