MEDICARE: FULL CIRCLE THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1689541195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE THERAPY LLC

Provider Business Mailing Address
First Line	:	2919 CROSSING CT STE 8
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-5904
Country	:	US
Telephone Number	:	217-275-8811
Fax Number	:	217-600-3205

Provider Business Practice Location Address
First Line	:	2919 CROSSING CT STE 8
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-5904
Country	:	US
Telephone Number	:	217-275-8811
Fax Number	:	217-600-3205

Authorized Official
Title or Position	:	OWNER
Name	:	KATHLEEN EL KOURY
Credential	:	LCSW
Telephone Number	:	217-275-8811

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	11/01/2025

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Directions to “FULL CIRCLE THERAPY LLC ” Practice Location

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