Healthcare Provider Details

I. General information

NPI: 1205709938
Provider Name (Legal Business Name): KSHEP COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N RANDOLPH ST STE 412
CHAMPAIGN IL
61820-3978
US

IV. Provider business mailing address

206 N RANDOLPH ST STE 412
CHAMPAIGN IL
61820-3978
US

V. Phone/Fax

Practice location:
  • Phone: 815-317-6501
  • Fax:
Mailing address:
  • Phone: 815-317-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KEVIN SHEPHERD
Title or Position: THERAPIST, OWNER
Credential: LCSW
Phone: 815-317-6501