Healthcare Provider Details

I. General information

NPI: 1518425230
Provider Name (Legal Business Name): KC COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N RANDOLPH ST STE 508
CHAMPAIGN IL
61820-3949
US

IV. Provider business mailing address

1104 W PARK AVE
CHAMPAIGN IL
61821-3245
US

V. Phone/Fax

Practice location:
  • Phone: 217-377-0299
  • Fax: 855-750-3291
Mailing address:
  • Phone: 217-621-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAITLYN CORNELL
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 217-377-0299