Healthcare Provider Details

I. General information

NPI: 1326834946
Provider Name (Legal Business Name): BECOMING WELLNESS. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 S NEIL ST STE 2
CHAMPAIGN IL
61820-7262
US

IV. Provider business mailing address

2816 N 1100 EAST RD
MANSFIELD IL
61854-6857
US

V. Phone/Fax

Practice location:
  • Phone: 872-256-8818
  • Fax:
Mailing address:
  • Phone: 815-383-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN GRIMES
Title or Position: OWNER
Credential:
Phone: 815-383-7461