Healthcare Provider Details

I. General information

NPI: 1184412827
Provider Name (Legal Business Name): KC COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N MATTIS AVE STE 209
CHAMPAIGN IL
61821-2461
US

IV. Provider business mailing address

203 FLORA DR
CHAMPAIGN IL
61821-3212
US

V. Phone/Fax

Practice location:
  • Phone: 217-621-0766
  • Fax:
Mailing address:
  • Phone: 217-621-0766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAITLYN CORNELL
Title or Position: CEO
Credential: LCSW, CEDS-S
Phone: 217-621-0766